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Kiesselbach’s Plexus

The nose is a primary point of entry for air to get into the lungs. As this air enters, it is important that its temperature is adjusted for optimum gas transfer in the lungs. This adjustment is achieved via heat exchange between the air and the blood being supplied to the nasal cavity. This is one of the primary reasons for the relatively large blood supply to the nasal cavity.

Kiesselbach’s plexus is an integral anastomosis of five branches converging in the anterior inferior quadrant of the nasal septum (over the septal cartilage). The area has been referred to as Little’s Area, Kiesselbach’s Triangle or Kiesselbach’s Area. Little’s area is a common site of epistaxis (nose bleeds) in both paediatric and adult cases.

Recommended video: Blood vessels of nasal cavity
Arteries and veins of the nasal cavity.

Branches of the Anastomosis

Branching from the maxillary artery, the sphenopalatine artery enters the nasal cavity via the sphenopalatine foramen and supplies the septal wall of the cavity.

Sphenopalatine artery - medial view

Sphenopalatine artery - medial view

Entering through the orbit, the septal branches of the anterior and posterior ethmoidal arteries (branches of the ophthalmic artery) gives supply to the roof as well as the septal wall of the cavity as it travels to Little’s area.

Septal and lateral nasal branches of posterior ethmoidal artery - medial view

Septal and lateral nasal branches of posterior ethmoidal artery - medial view

The facial artery gives off the superior labial artery; the septal branch of which enters the nasal cavity through the nares and joins the anastomoses in Little’s area.

Superior labial artery - lateral-right view

Superior labial artery - lateral-right view

The greater palatine artery, a terminal branch of the maxillary artery, passes through the greater palatine foramen and travels along the hard palate to enter the nasal cavity by way of the incisive canal, thus joining the anastomosis in Kiesselbach’s area.

Greater palatine artery - medial view

Greater palatine artery - medial view

Therefore, Little’s area – and the nasal cavity in general – receives arterial supply from both the external (greater palatine, sphenopalatine and superior labial arteries) and the internal (anterior and posterior ethmoidal arteries) carotid arteries.

For completion, the blood supply to this area is drained by accompanying veins. The deoxygenated blood is returned to systemic circulation via the facial vein, ophthalmic veins, and pterygoid plexus.

Pterygoid plexus - lateral-left view

Pterygoid plexus - lateral-left view


Epistaxis, or nose bleeds, is the most common pathological processes associated with Little’s area. While the exact aetiology remains elusive, there are several conditions that may precipitate nasal bleeding. Some cases have been described as spontaneous. These are usually precipitated by trauma or an underlying infection and most often occur at Little’s area. Spontaneous nose bleeds are most often seen in young adults and children. Alternatively, epistaxis may occur without external trauma and originate in the superior posterior region of the nasal cavity. This is often referred to as hypertensive epistaxis and is more prevalent in individuals in the older age groups.

Spontaneous epistaxis is more likely to recur than hypertensive epistaxis. However, it is significantly easier to treat. Nose bleeds from Little’s area are best controlled by vascular compression (pressing down the ala on the septum). In a clinical setting, packing the affected cavity with cotton wool treated with phenylepherine and lidocaine can control the bleeding if left for about 10 minutes. In extreme cases, where bleeding is persistent, cauterization of the vessels (under local anaesthetic for compliant adults or general anaesthetic for children) is a suitable option for management of the bleeding.

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Show references


  • Bull, P. D. Lecture Notes On Diseases Of The Ear, Nose, And Throat. 9th ed. Osney Mead, Oxford: Blackwell Science, 2002. Print.
  • Hansen, John T, and Frank H Netter. Netter's Atlas Of Human Anatomy. 6th ed. Philadelphia, Penn.: Sanders Elsevier, 2014. Print.
  • Sinnatamby, Chummy S, and R. J Last. Last's Anatomy. 12th ed. Edinburgh: Churchill Livingstone/Elsevier, 2011. Print.

Author and Layout:

  • Lorenzo A. Crumbie
  • Catarina Chaves


  • Sphenopalatine artery - medial view - Begoña Rodriguez
  • Septal and lateral nasal branches of posterior ethmoidal artery - medial view - Begoña Rodriguez
  • Superior labial artery - lateral-right view - Paul Kim
  • Greater palatine artery - medial view - Begoña Rodriguez
  • Pterygoid plexus - lateral-left view - Yousun Koh
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Related Atlas Images

Lateral wall of the nasal cavity

Medial wall of the nasal cavity

Blood vessels of the nasal cavity

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