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

Explanation

## Anatomy of Epistaxis Sites **Key Point:** Little's area (Kiesselbach's triangle) is the site of 90% of anterior epistaxis and accounts for the majority of all nosebleeds in both children and adults. ### Kiesselbach's Triangle — Anatomical Boundaries Little's area is a highly vascularized region in the anteroinferior part of the nasal septum, formed by the anastomosis of five arteries: | Artery | Origin | Contribution | | --- | --- | --- | | Anterior ethmoidal | Ophthalmic artery | Superolateral | | Sphenopalatine | Terminal branch of maxillary | Posteroinferior | | Greater palatine | Maxillary artery | Posteroinferior | | Septal branch of superior labial | Facial artery | Anteroinferior | | Terminal branches of septal artery | Anterior ethmoidal | Superolateral | **High-Yield:** This area is easily traumatized by digital trauma (nose-picking), making it the most common source of epistaxis in children. ### Clinical Presentation - **Anterior epistaxis** (90%): Bleeding from Little's area; blood flows anteriorly out of the nostrils - **Posterior epistaxis** (10%): From sphenopalatine or posterior ethmoidal arteries; blood flows into the nasopharynx and oropharynx **Clinical Pearl:** Posterior epistaxis is more common in elderly patients with hypertension and atherosclerosis, and typically requires more aggressive management (posterior packing or endoscopic cauterization). **Mnemonic:** **KIESSELBACH** — Remember the five vessels: **K**iesselbach (anterior ethmoidal), **I**nferior labial, **E**thmoidal, **S**phenopalatine, **S**uperior labial, **E**thmoidal, **L**abial, **B**ranch, **A**rtery, **C**ircle, **H**igh-risk. Alternatively: **SEALS** — **S**phenopalatine, **E**thmoidal (anterior), **A**nterior labial, **L**ittle's area, **S**eptal branches.