Kiesselbach's plexus is an
anastomotic
An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be norm ...
arterial network (plexus) of four or five
arteries
An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pul ...
in the
nose
A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next pass ...
supplying the
nasal septum
The nasal septum () separates the left and right airways of the nasal cavity, dividing the two nostrils.
It is depressed by the depressor septi nasi muscle.
Structure
The fleshy external end of the nasal septum is called the columella or col ...
. It lies in the anterior inferior part of the septum known as Little's area, Kiesselbach's area, or Kiesselbach's triangle. It is a common site for
nosebleed
A nosebleed, also known as epistaxis, is bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low blo ...
s.
Structure
Kiesselbach's plexus is an anastomosis of four or five arteries:
* the
anterior ethmoidal artery
The anterior ethmoidal artery is a branch of the ophthalmic artery in the orbit. It exits the orbit through the anterior ethmoidal foramen. The posterior ethmoidal artery is posterior to it.
Structure
The anterior ethmoidal artery branches from ...
, a branch of the
ophthalmic artery
The ophthalmic artery (OA) is an artery of the head. It is the first branch of the internal carotid artery distal to the cavernous sinus. Branches of the ophthalmic artery supply all the structures in the orbit around the eye, as well as some st ...
.
[Moore, Keith L. et al. (2014) ''Clinically Oriented Anatomy'', 7th Ed, p.959]
* the
sphenopalatine artery
The sphenopalatine artery (nasopalatine artery) is an artery of the head, commonly known as the artery of epistaxis.
Course
The sphenopalatine artery is a branch of the maxillary artery which passes through the sphenopalatine foramen into the cav ...
, a terminal branch of the
maxillary artery
The maxillary artery supplies deep structures of the face. It branches from the external carotid artery just deep to the neck of the mandible.
Structure
The maxillary artery, the larger of the two terminal branches of the external carotid artery, ...
.
* the
greater palatine artery
The greater palatine artery is a branch of the descending palatine artery (a terminal branch of the maxillary artery) and contributes to the blood supply of the hard palate and nasal septum.
Course
The descending palatine artery branches off of ...
, a branch of the
maxillary artery
The maxillary artery supplies deep structures of the face. It branches from the external carotid artery just deep to the neck of the mandible.
Structure
The maxillary artery, the larger of the two terminal branches of the external carotid artery, ...
.
* a septal branch of the
superior labial artery
The superior labial artery (superior labial branch of facial artery) is larger and more egregious than the inferior labial artery.
It follows a similar course along the edge of the upper lip, lying between the mucous membrane and the orbiculari ...
, a branch of the
facial artery
The facial artery (external maxillary artery in older texts) is a branch of the external carotid artery that supplies structures of the superficial face.
Structure
The facial artery arises in the carotid triangle from the external carotid arter ...
.
* a
posterior ethmoidal artery
The posterior ethmoidal artery is an artery of the head which supplies the nasal septum. It is smaller than the anterior ethmoidal artery.
Course
Once branching from the ophthalmic artery, it passes between the upper border of the medial rectus m ...
, a branch of the
ophthalmic artery
The ophthalmic artery (OA) is an artery of the head. It is the first branch of the internal carotid artery distal to the cavernous sinus. Branches of the ophthalmic artery supply all the structures in the orbit around the eye, as well as some st ...
.
There is contention as whether this is truly part of Kiesselbach's plexus. Most sources quote that it is not part of the plexus, but rather one of the blood supplies for the nasal septum itself.
It runs vertically downwards just behind the columella, and crosses the floor of the
nose
A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next pass ...
. It joins the venous plexus on the lateral nasal wall.
Function
Kiesselbach's plexus supplies blood to the
nasal septum
The nasal septum () separates the left and right airways of the nasal cavity, dividing the two nostrils.
It is depressed by the depressor septi nasi muscle.
Structure
The fleshy external end of the nasal septum is called the columella or col ...
.
Clinical significance
Ninety percent of
nosebleed
A nosebleed, also known as epistaxis, is bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low blo ...
s (epistaxis) occur in Kiesselbach's plexus.
It is exposed to the drying effect of
inhaled
Inhalation (or Inspiration) happens when air or other gases enter the lungs.
Inhalation of air
Inhalation of air, as part of the cycle of breathing, is a vital process for all human life. The process is autonomic (though there are exceptions ...
air.
It can also be damaged by trauma from a
finger nail
A nail is a claw-like plate found at the tip of the Finger, fingers and Toe, toes on most primates. Nails correspond to the claws found in other animals. Fingernails and toenails are made of a tough protective protein called alpha-keratin, which i ...
(
nose-picking
Nose-picking is the act of extracting nasal mucus with one's finger (rhinotillexis) and may include the subsequent ingestion of the extracted mucus (mucophagy).
In Western cultures, this act is generally considered to be social deviant; parent ...
), as it is fragile.
It is the usual site for nosebleeds in children and young adults.
A
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
may use a nasal speculum to see that an anterior nosebleed comes from Kiesselbach's plexus.
History
James Lawrence Little (1836–1885), an
American
American(s) may refer to:
* American, something of, from, or related to the United States of America, commonly known as the " United States" or "America"
** Americans, citizens and nationals of the United States of America
** American ancestry, ...
surgeon, first described the area in detail in 1879. Little described the area as being "about half an inch ... from the lower edge of the middle of the column
eptum.
Kiesselbach's plexus is named after
Wilhelm Kiesselbach (1839–1902), a
German
German(s) may refer to:
* Germany (of or related to)
**Germania (historical use)
* Germans, citizens of Germany, people of German ancestry, or native speakers of the German language
** For citizens of Germany, see also German nationality law
**Ger ...
otolaryngologist
Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspeciality within medicine that deals with the surgical a ...
who published a paper on the area in 1884. The area may be called Little's area,
Kiesselbach's area, or Kiesselbach's triangle.
See also
*
Anatomical terms of location
Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position ...
References
External links
Epistaxis- utmb.edu
- emedicine.com
- fpnotebook.com
{{Portal bar, Anatomy
Human anatomy
Anatomy named for one who described it