Little's or Kiesselbach's Area and Epistaxis

The Capillary Anastomosis Area In The Nose Where Nose Bleeding is Most Common: Kiesselbach's Area

Nosebleed,epistaxis,Little's area, Kiesselbach's area, Kiesselbach plexus
In the photo above, the area of superficial vascular anastomosis in the mucosa, marked in the pink round area and located just behind the columella, in the anterior part of the nasal septum, known as the Locus Kiesselbachi / Kiesselbach's area / Little's area / Kiesselbach's triangle

It is an arterial anastomosis in the septum nasal mucosa; its location is known as the Locus Kiesselbachi / Kiesselbach's area / Little's area / Kiesselbach's triangle / Kiesselbach plexus. Little area is where epistaxis is most common.

Arteries joining the Kiesselbach Plexus:

- Anterior ethmoid artery (branch of ophthalmic artery)
- Sphenopalatine artery (Terminal branch of the maxillary artery)
- Arteria palatina major (branch of the maxillary artery)
- Septal branches of superior labial artery (branch of facial artery)

The Kiesselbach plexus is a vascular network consisting of five arteries that supply the nasal septum. Arteries anastomose to form the plexus, a common site for nosebleeds. James Lawrence Little (1836-1885), an American surgeon, first described the area in detail in 1879. The Kiesselbach plexus is named after German otolaryngologist Wilhelm Kiesselbach (1839–1902), who published an article on the region in 1884. This area is responsible for 90% of all epistaxis. The Little area is in the front lower part of the septum nasi. The Kiesselbach plexus is the most common location of this plexus epistaxis located on the Little area. Plexus a. with the branches of facialis a. sphenopalatina's branches make.

Little's or Kiesselbach's Area and Epistaxis

Especially in children and young people, after mechanical trauma with a finger or a foreign body, nosebleeds can easily start in this area and it is prone to recurrence. Factors that can cause the onset of bleeding in Little's area are: trauma, including insertion of the finger into the nose, blood thinners, high blood pressure, alcoholism, seasonal allergies, dry air, and inhaled corticosteroids. 

When people make a comment as if "my child has veins in the situation and spontaneously cracks", this vascular plexus should come to mind. Although it is not a life-threatening condition, it can be talked about frequently because it causes recurrent nosebleeds and recurrent bleeding after intranasal finger and traumas in young children. During physical examination, when this vascular bundle and the bleeding area with a small clot are seen in the anterior part of the nasal septum, it can be understood that there are cracks in this capillary vessel area as a simple recurrent bleeding cause without any bleeding coagulation disorder in patients. In cases of nosebleeds from the capillary vessel area determined in this way, it is generally not necessary to evaluate the coagulation factors in the blood, bleeding time, coagulation time, and perform laboratory tests as further investigations.

The Capillary Anastomosis Area In The Nose Where Nose Bleeding is Most Common: Kiesselbach's Area

How is a treatment planned when there is bleeding from Kiesselbach plexus?

Generally, at the time of bleeding, it is sufficient for the patient to use two fingers to switch to the tip of the nose for 5-10 minutes. With just a few minutes of finger pressure, bleeding usually tends to stop. Cold can be applied to the upper lip and face area, it is important for the patient to stand upright and sit in a cold or cool environment. Paying attention to risk factors that may cause nosebleeds (not to mix the nose, not to insert a napkin or finger into the nose, not to apply cortisone to dry the mucosa in the nose, not to strain and pressure blowing ...). It is important to use local moisturizing products for patients with very dry nasal mucosa. When there is bleeding in this area, sometimes when patients try to make a napkin or a burp with a finger, more damage may occur in the vessels in the mucosa and the nosebleed may subsequently become more severe. It is important to inform patients about this issue. In patients with recurrent epistaxis, after inserting cotton impregnated with a local anesthetic, silver nitrate application or radiofrequency cauterization can be performed.

nosebleed,Kiesselbach's area,Kiesselbach's triangle,Little's area,Locus Kiesselbachi,epistaxis,Kiesselbach plexus,

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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