Kiesselbach Plexus

What is the Kiesselbach plexus?

The Kiesselbach plexus is an anastomotic arterial network located on the anterior inferior nasal septum (Little’s area). This region serves as the most frequent origin for anterior epistaxis (nosebleeds), accounting for over 90% of cases. Clinicians frequently encounter bleeding from Kiesselbach’s plexus in children and young adults. The overlying mucosa is exceptionally thin and lacks significant protection, making the fragile vessels susceptible to drying or minor mechanical trauma.

What is the structure of the Kiesselbach plexus?

The Kiesselbach plexus is formed by anastomoses among septal branches of the anterior ethmoidal, sphenopalatine, greater palatine, and superior labial arteries, with some descriptions also including a posterior ethmoidal contribution. The anterior ethmoidal artery, a branch of the ophthalmic artery, contributes supply from the internal carotid system. The external carotid system contributes via the sphenopalatine, greater palatine, and superior labial arteries.

These vessels lie superficially in Little’s area. Because the mucosa in this area is thin and the vessels are superficial, Little’s area is particularly prone to bleeding. Drying or minor trauma can easily disrupt these superficial vessels and cause a typical Kiesselbach plexus nosebleed.

What is the clinical significance of the Kiesselbach plexus?

Because Little’s area contains superficial arterial anastomoses on the anterior septum, it is the most common site of anterior epistaxis. Most Kiesselbach plexus nosebleed episodes present as mild to moderate bleeding that is managed with direct pressure or topical vasoconstrictors. Factors such as low humidity, anticoagulant therapy, and digital trauma increase the risk of mucosal disruption in this area. In refractory cases, practitioners may utilize chemical cautery with silver nitrate or nasal packing to achieve hemostasis.

What are the most important facts to know about the Kiesselbach plexus?

• The Kiesselbach plexus is an anastomotic arterial network located on the anterior inferior nasal septum and is the most common site of anterior epistaxis.
• It is formed by septal branches of the anterior ethmoidal, sphenopalatine, greater palatine, and superior labial arteries; some sources also include the posterior ethmoidal artery.
• The region is prone to bleeding because the mucosa is thin and the arterial network is superficial.
• Identifying Little’s area as the bleeding source supports an anterior epistaxis diagnosis and guides first-line local treatment.
• Initial management of a Kiesselbach plexus nosebleed starts with direct pressure and may escalate to cautery or nasal packing if bleeding persists.