A 35-year-old man presents to the ENT clinic with recurrent epistaxis over the past 6 months. Anterior rhinoscopy reveals a vascular lesion in the anteroinferior part of the nasal septum. What is the most common site of epistaxis in adults?

Explanation

## Anatomy of Epistaxis Sites **Key Point:** Kiesselbach's plexus (Little's area) is the most common site of epistaxis in adults, accounting for approximately 90% of anterior epistaxis cases. ### Kiesselbach's Plexus — Location & Vascular Supply Kiesselbach's plexus is a highly vascular anastomotic zone located in the **anteroinferior part of the nasal septum**, approximately 0.5–1 cm from the nostril. It is formed by the convergence of five arteries: 1. **Anterior ethmoidal artery** (from above) 2. **Sphenopalatine artery** (posteroinferior) 3. **Greater palatine artery** (inferoposterior) 4. **Septal branch of superior labial artery** (anteroinferior) 5. **Septal branch of superior alveolar artery** (inferior) ### Why This Site Is Prone to Bleeding - **Exposed mucosa:** The mucosa over Kiesselbach's plexus is thin and easily traumatized. - **High vascularity:** Dense vascular anastomoses create a vulnerable network. - **Anterior location:** Exposed to trauma from nose-picking, dry air, and minor nasal manipulation. - **Low pressure:** Venous drainage is relatively sluggish, increasing bleeding risk. ### Clinical Significance **High-Yield:** Anterior epistaxis (from Kiesselbach's plexus) typically presents as blood flowing out of the nostrils and is self-limiting in most cases. It accounts for 80–90% of all epistaxis cases. **Clinical Pearl:** Posterior epistaxis (from sphenopalatine artery) is less common but more severe, presents as blood in the pharynx, and is more likely to require intervention. ### Management Approach ```mermaid flowchart TD A[Epistaxis]:::outcome --> B{Anterior or Posterior?}:::decision B -->|Anterior<br/>Kiesselbach's plexus| C[Pinch nostrils<br/>Head forward]:::action B -->|Posterior<br/>Sphenopalatine artery| D[Posterior packing or<br/>Endoscopic intervention]:::action C --> E[Topical hemostatic agents<br/>Cautery if recurrent]:::action E --> F[Resolve in most cases]:::outcome D --> G[Higher morbidity<br/>May need transfusion]:::outcome ``` **Mnemonic:** **KIESSELBACH** — **K**iesselbach's plexus is the **K**ey site (anteroinferior nasal septum, 90% of epistaxis). [cite:Scott-Brown's Otolaryngology 8e Ch 23]