Which of the following is the most common site of epistaxis in children?

Explanation

## Anatomical Sites of Epistaxis **Key Point:** Epistaxis is classified into anterior (90%) and posterior (10%) based on bleeding site, with distinct vascular and demographic patterns. ### Anterior Epistaxis (90% of cases) **Kiesselbach's plexus (Little's area)** is the most common site of epistaxis overall, particularly in children and young adults. This is a highly vascular anastomotic zone located in the anteroinferior part of the nasal septum, formed by convergence of: - Anterior ethmoidal artery - Sphenopalatine artery - Greater palatine artery - Septal branch of superior labial artery **Clinical Pearl:** Kiesselbach's plexus bleeds are typically self-limited, low-volume, and respond well to conservative management (pressure, cautery). ### Posterior Epistaxis (10% of cases) Posterior bleeds arise from the **sphenopalatine artery** and its branches, typically in elderly patients with hypertension or coagulopathy. These are high-volume, difficult to control, and often require posterior packing or endoscopic intervention. ### Why Kiesselbach's in Children? 1. Thin mucosa with prominent vasculature 2. Trauma (nose-picking) is the leading cause 3. Anterior location makes it accessible to digital manipulation 4. Lower systemic blood pressure = slower bleeding rate **High-Yield:** In exam questions, "epistaxis in children" almost always refers to Kiesselbach's plexus bleeding from trauma or idiopathic causes. | Feature | Anterior (Kiesselbach) | Posterior (Sphenopalatine) | | --- | --- | --- | | **Frequency** | 90% | 10% | | **Age group** | Children, young adults | Elderly | | **Volume** | Low | High | | **Visibility** | Visible on anterior rhinoscopy | Requires posterior examination | | **Management** | Pressure, cautery, anterior packing | Posterior packing, endoscopy, angiography |