Reference Material
Vascular Supply & Epistaxis
Anterior Epistaxis (Kiesselbach Plexus): Most Common (>90%), Anteroinferior nasal septum. Arteries: Anterior ethmoidal art., Sphenopalatine art., Superior labial art. (Facial art. branch), Greater palatine art. Management: Direct compression of alae; Cautery (silver nitrate).
Posterior Epistaxis: Less common; more severe, Posterolateral wall / Posterior choanae. Arteries: Sphenopalatine artery (primary source). Management: Posterior packing; Surgery (cannot be treated with simple cautery).
Lateral Nasal Wall
Superior Meatus: Sphenoidal & Posterior ethmoidal sinuses drainage. Deepest part of the nasal cavity.
Middle Meatus: Frontal, Maxillary, & Anterior ethmoidal sinuses drainage. Most common site for nasal polyps.
Inferior Meatus: Nasolacrimal duct drainage. Why your nose runs when you cry.
USMLE Mnemonics & Tips
- Kiesselbach Plexus (The "LEGS" of the Nose): L: Superior Labial artery, E: Ethmoidal artery (Anterior), G: Greater palatine artery, S: Sphenopalatine artery
- Posterior Bleeds: If a patient has a nosebleed that is dripping down the back of the throat and cannot be stopped by pinching the nose, think Sphenopalatine artery.
- Maxillary Sinus: Remember that the maxillary sinus drains upward into the middle meatus, which is why it is the most common sinus to stay infected (gravity works against it when you are upright).
