Nosebleed (Epistaxis)

One of the most frequent ear, nose, and throat (ENT) emergencies seen in the emergency room or primary care clinic is epistaxis (nosebleed). Anterior (more popular) and posterior nosebleeds (less frequent, but more likely to need medical attention) are the two types of nosebleeds. The Kiesselbach's plexus (also referred to as Little's area) on the anterior nasal septum is the origin of 90% of anterior nosebleeds. The nasal cavity is supplied by five identified vessels with terminal branches:

• Anterior ethmoidal artery
• Posterior ethmoidal artery
• Sphenopalatine artery
• Greater palatine artery
• Superior labial artery

Kiesselbach's plexus is the watershed area of these five veins, which is located in the anterior nasal septum. Because it is located near the entrance to the nasal cavity, it is exposed to extremes of heat and cold, as well as high and low moisture levels, and is readily traumatized. Because the mucosa over the septum in this location is so thin, it is the most common site of epistaxis. The so-called posterior epistaxis occurs when arteries in the back or superior nasal cavity bleed. Patients on blood thinners, hypertensive patients, and those with underlying blood dyscrasia or vascular disorders are more likely to experience this. The degree of the bleeding and the patient's other medical issues will determine how the patient is treated.