From the Guidelines
Anterior epistaxis is located in the front part of the nasal cavity, specifically in the area of Kiesselbach's plexus (also called Little's area) on the anterior nasal septum. This region is where multiple blood vessels converge, including branches from the superior labial artery, greater palatine artery, sphenopalatine artery, and anterior ethmoidal artery. According to the clinical practice guideline on nosebleed (epistaxis) published in 2020 1, anterior nosebleeds are the most common type, accounting for approximately 90% of all epistaxis cases. They typically present with blood flowing out of the front of the nostril and can often be controlled with simple measures like applying direct pressure by pinching the soft part of the nose for 10-15 minutes, using topical vasoconstrictors such as oxymetazoline, or chemical cautery with silver nitrate. The guideline suggests that initial therapy for anterior epistaxis may consist of topical treatments, including application of vasoconstricting agents such as oxymetazoline, phenylephrine, epinephrine, or cocaine and/or use of nasal cautery 1.
Some key points to consider in the management of anterior epistaxis include:
- The use of topical vasoconstrictors, which can be effective in resolving nasal bleeding in 65% to 75% of patients 1
- The potential risks associated with the use of these agents, including an increased risk of cardiac or other systemic complications 1
- The importance of humidification, intranasal emollients, and other supportive measures to prevent additional bleeding at the identified site 1
- The accessibility of the anterior location for examination and treatment, which generally results in a better prognosis than posterior epistaxis.
Overall, the management of anterior epistaxis should prioritize measures to control bleeding, prevent recurrence, and minimize potential complications, as outlined in the clinical practice guideline 1.
From the Research
Location of Anterior Epistaxis
- Anterior epistaxis is typically located in the anterior nasal septum, specifically in an area known as Kiesselbach's plexus 2, 3, 4.
- This area is a vascular network in the anterior portion of the nasal septum, where most nosebleeds arise 2, 4.
- Other possible locations of anterior epistaxis include the small area of anterior lateral wall of nasal cavity corresponding to the nasal back, the anterior end of the inferior turbinate, and the nasal part of the nasal cavity roof 5.
- Anterior epistaxis is usually due to anterior circulation bleeding at Kiesselbach's plexus (Little's area), which is supplied by five vessels, including the septal branch of the superior labial artery 3.
Characteristics of Anterior Epistaxis
- Anterior nosebleeds are the least dangerous and the most common, especially among children 6.
- They can be reached easily and stopped by pinching the nostrils, applying silver nitrate cautery, or lightly packing the anterior nose 6.
- Anterior epistaxis is often caused by fragile and hyperemic nasal mucosa that bleeds easily with nose blowing or mild abrasion, which can be triggered by sinus disease, colds, allergies, abrupt temperature changes, and dry heat 6.