Recently, we have seen and read reports on posterior epistaxis origin being frequently located on the upper nasal septum (1).
On my personal experience, this is by far the most frequent source on previously untreated patients.
I ask your opinion on this finding and weather you have the same experience.
Thank you
1. Kosugi EM, Balsalobre L, Stamm AC. Breaking paradigms in severe epistaxis: the importance of looking for the S-point. Braz J Otorhinolaryngol. 2018 May - Jun;84(3):290-297.
Classically, epistaxis is divided into anterior and posterior types, although exact criteria are often not standardized. Anterior epistaxis is often associated with Kiesselbach's plexus, whereas the posterior variety is often thought to be linked to the sphenopalatine artery (Woodruff's plexus). Anterior epistaxis consists of approximately 80% of total cases. Anterior epistaxis generally occurs in children and young adults and is frequently caused by trauma (nose picking!) and drying. Posterior epistaxis takes up the remaining 20% of total cases. Posterior bleeds occur much more frequently in adults older than 50 years of age. There is a male predominance in adults younger than age 49, and some attribute this to the protective effects of estrogen in females.
Kiesselbach's plexus is a confluence of vessels arising from both the internal and external carotid artery systems. It supplies an area on the anterior-inferior septum known as Little's area, a common site for epistaxis. Although this area is easily irritated (via digital trauma, cold, dry air, cigarette smoke, etc.), it is also easier to access and treat than sites of bleeding deeper in the nasal cavity.
Woodruff's plexus is another name for the sphenopalatine artery as it exits the sphenopalatine foramen. Woodruff's plexus should be found approximately 1 cm inferior and 1 cm anterior to the posterior margin of the middle turbinate.
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