It receives blood supply from both internal and external carotid arteries.Īpproximately 10% of episodes of epistaxis are posterior bleeds. 2 The Keisselbach’s plexus is an anastomotic network of vessels located on the anterior cartilaginous septum. More than 90% of episodes of epistaxis occur along the anterior nasal septum, which is supplied by Keisselbach’s plexus in a site known as the Little’s area. This division lies at the piriform aperture anatomically. Blood supply to the nasal septumĮpistaxis is most commonly classified into anterior or posterior bleeds. The facial artery is the second major branch of the external carotid to supply the nose, which also contributes to Keisselbach’s plexus.įigure 1. These contribute to Keisselbach’s plexus and supply up to 80% of the nasal vault. The internal maxillary divides into six branches and includes the greater palatine and sphenopalatine arteries (SPA). The facial and the internal maxillary artery are the two branches involved in the supply of the nasal cavity and are part of the external carotid. The ethmoidal arteries, branches of the internal carotid, enter the nose superiorly and supply the upper extremes of the septum and lateral nasal wall. The arterial supply arises from branches of both the internal and external carotid arteries ( Figure 1). The nose has a rich vascular anatomy with multiple anastomoses. Successful treatment requires knowledge of the possible causes of epistaxis and a detailed knowledge of nasal anatomy. The management of epistaxis has evolved significantly in recent years. As most episodes are minor, the GP’s role is important in recognising signs and symptoms suggestive of more sinister medical conditions. Patients rarely need to be transferred to a hospital with the aim of being treated by an ear, nose and throat (ENT) specialist. Application of proper first aid is often all that is required. They present to their general practitioner (GP) only when the condition changes or worsens. 1 Many patients self-manage this condition as it is often spontaneous and self-limiting. However, only a very small proportion requires specialist management. The lifetime incidence of epistaxis is difficult to determine, but has been reported to be as high as 60%. Epistaxis is a challenging and common condition.
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