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Kiesselbach’s plexus

Recommended video: Blood vessels of nasal cavity [13:27]
Arteries and veins of the nasal cavity.

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.

  1. Branches of the anastomosis
  2. Epistaxis
  3. Sources
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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

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

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

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

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

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