Kiesselbach's plexus

Kiesselbach's plexus is a region located on the anteroinferior portion of the nasal septum where multiple arterial branches converge to form a rich vascular plexus beneath a thin mucosal layer.

Vascular anatomy

Little's area is supplied by anastomotic branches from both the internal and external carotid artery systems. Five vessels contribute to this plexus:

• Anterior ethmoidal artery (from the internal carotid system via the ophthalmic artery)

• Posterior septal artery (a branch of the sphenopalatine artery, from the external carotid system)

• Greater palatine artery (from the external carotid system)

• Superior labial artery (septal branch, from the facial artery / external carotid system)

• Septal branches of the posterior ethmoidal artery

These vessels anastomose freely under the thin mucosa of the anterior septum, creating the Kiesselbach plexus a dense, superficial vascular network that is particularly vulnerable to trauma, desiccation, and inflammation.

Clinical significance

Little's area is the most common site of origin for epistaxis, accounting for approximately 80-90% of all nosebleeds. Bleeding from this area is classified as anterior epistaxis and is generally easier to control than posterior epistaxis. The superficial location of the plexus and the thin overlying mucosa make it susceptible to bleeding from minor trauma (including digital manipulation), dry air, crusting, and mucosal inflammation. In children, recurrent idiopathic epistaxis is almost always venous in origin and arises from Little's area, often perpetuated by a cycle of crusting, itching, and repeated trauma.