What is the most common site of hemorrhage for epistaxis (nosebleed)?

From the Guidelines

The most common site of hemorrhage for epistaxis is Little's area, also known as Kiesselbach's plexus, located on the anterior nasal septum. This area is highly vascularized, with multiple blood vessels converging, including branches from both the internal and external carotid arteries, as illustrated in the study by Tunkel et al 1. Approximately 90% of nosebleeds originate from this anterior location, making it the predominant source of epistaxis. The area is particularly vulnerable to bleeding because the blood vessels here lie close to the surface of the nasal mucosa, which is thin and easily damaged by trauma, dryness, or digital manipulation (nose picking).

Some key points to consider when evaluating the site of hemorrhage for epistaxis include:

• The vascular supply of the nasal septum and lateral nasal wall, as shown in Figure 1 of the study by Tunkel et al 1
• The role of Kiesselbach's plexus, also known as Little's area, in the majority of epistaxis cases
• The effectiveness of direct pressure applied to this area as first-line management for anterior epistaxis, as supported by the study 1

The study by Tunkel et al 1 provides the most recent and highest quality evidence for the management of epistaxis, and its findings support the recommendation that Little's area is the most common site of hemorrhage for epistaxis.

From the Research

Most Common Site of Hemorrhage for Epistaxis

The most common site of hemorrhage for epistaxis is an area known as Kiesselbach's plexus, also referred to as Little's area 2, 3, 4, 5. This area is located on the anterior nasal septum and is supplied by five vessels, making it a common source of bleeding.

Characteristics of Little's Area

• Located on the anterior nasal septum 2, 3, 4, 5
• Supplied by five vessels, including the septal branch of the superior labial artery 2
• Common source of bleeding for epistaxis 2, 3, 4, 5
• Can be managed with various techniques, including sub-labial packing 2, topical vasoconstrictors, direct pressure, cautery, and nasal tampons 3, 5

Comparison to Other Sites

• Posterior nasal cavity is a less common site of hemorrhage for epistaxis, but can be more difficult to control 3, 5
• Nasopharynx and nostril are not typically identified as common sites of hemorrhage for epistaxis in the available studies 2, 3, 4, 5