Classification of epistaxis

Epistaxis is usually classified into two types (1):

• anterior bleeding
  • more common - seen in around 90% of cases (2)
  • occurs in the anterior septal area which is supplied by Keisselbach’s plexus in a site known as the Little’s area
    • Kiesselbach's plexus is supplied by both external and internal carotid artery branches (2)
  • is clinically obvious (4)
    
• posterior bleeding
  • present in around 10% of cases (2)
  • usually arises in the posterior nasal cavity at the following sites
    • behind the posterior part of the middle turbinate
    • the posterior superior roof of the nasal cavity
• involves branches of the sphenopalatine arteries which forms part of the Woodruff plexus (1)
• sometimes involves large vessels resulting in sudden massive bleeding
• may be subtle or may present with an insidious onset as hematemesis, nausea, anemia, hemoptysis or melena (4)
• more common in older patients - mean age was 64 years according one study (2)

Reference:

• (1) Pope LE, Hobbs CG. Epistaxis: an update on current management. Postgrad Med J. 2005;81(955):309-14
• (2) Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med. 2009;360(8):784-9
• (3) Willems PW, Farb RI, Agid R. Endovascular treatment of epistaxis. AJNR Am J Neuroradiol. 2009;30(9):1637-45
• (4) Kucik CJ. Management of epistaxis. American Family Physician 2005; 71(2)