## Anatomical Basis of Epistaxis Sites **Key Point:** Kiesselbach's plexus (Little's area) is the most common site of epistaxis, accounting for 90% of anterior bleeds. It is located in the anteroinferior part of the nasal septum in the region of the septal mucosa. ### Vascular Anatomy of Kiesselbach's Plexus The plexus is formed by the anastomosis of five arteries: 1. Anterior ethmoidal artery (superiorly) 2. Sphenopalatine artery (posteroinferiorly) 3. Greater palatine artery (inferiorly) 4. Septal branch of superior labial artery (anteroinferiorly) 5. Septal branch of the nasal septum **Mnemonic:** **ASGSS** — Anterior ethmoidal, Sphenopalatine, Greater palatine, Superior labial, Septal branches. ### Clinical Correlation **High-Yield:** Anterior bleeds (90% of epistaxis) originate from Kiesselbach's plexus and are typically self-limited or easily controlled with simple measures (topical hemostatics, anterior packing). This patient's anteroinferior septal bleeding that stopped with anterior packing is classic for Little's area. **Clinical Pearl:** Posterior epistaxis (from sphenopalatine artery) presents with blood draining into the nasopharynx and oropharynx, requires posterior packing or endoscopic cauterization, and is more common in elderly patients with hypertension. ### Risk Factors in This Case - **Hypertension:** Uncontrolled BP (168/98) increases bleeding risk - **Age:** 68 years — degenerative changes in septal mucosa - **Anterior location:** Consistent with Kiesselbach's plexus - **Easy control:** Responded to topical epinephrine and anterior packing (hallmark of anterior bleeds) [cite:Cummings Otolaryngology 6e Ch 41] 
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