A 35-year-old man presents to the ENT outpatient department 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

## Most Common Site of Epistaxis in Adults **Key Point:** Kiesselbach's area (also called Little's area) is the site of origin in 90% of anterior epistaxis cases and accounts for the majority of all epistaxis presentations. ### Anatomical Basis Kiesselbach's area is a highly vascular zone located in the anteroinferior part of the nasal septum where five arteries converge: 1. Anterior ethmoidal artery (superiorly) 2. Sphenopalatine artery terminal branch (posteroinferiorly) 3. Greater palatine artery (inferiorly) 4. Septal branch of superior labial artery (anteroinferiorly) 5. Septal branch of the nasal septum mucosa (rich venous plexus) ### Why This Site Is Vulnerable - Thin, non-keratinized mucosa overlying the vascular plexus - Exposed to dry air, trauma, and temperature changes - Anterior location makes it susceptible to digital trauma (nose-picking) - Rich vascular anastomoses create a pressure gradient ### Clinical Significance **High-Yield:** Anterior epistaxis (from Kiesselbach's area) comprises ~90% of all epistaxis; posterior epistaxis (from sphenopalatine artery) comprises ~10% but is more severe and difficult to control. | Feature | Anterior Epistaxis | Posterior Epistaxis | |---------|-------------------|--------------------| | **Site** | Kiesselbach's area | Sphenopalatine artery region | | **Frequency** | 90% | 10% | | **Age** | Younger patients, children | Older patients (>60 years) | | **Severity** | Mild to moderate | Severe, recurrent | | **Management** | Anterior packing, cautery | Posterior packing, endoscopic hemostasis | **Clinical Pearl:** In a young patient with recurrent epistaxis from Kiesselbach's area, always examine for digital trauma (nose-picking habit) and consider cauterization or topical hemostatic agents after ruling out coagulopathy. **Mnemonic:** **KIESSELBACH** = **K**ey site for **E**pistaxis; **I**nferior **E**thmoidal, **S**phenopalatine, **S**uperior labial, **E**xposed **L**ocation, **B**leeds **A**nteriorly, **C**ommon **H**emorrhage.