Classification of epistaxis

Epistaxis is usually classified into two types:

• anterior bleeding
  • more common - seen in around 90% of cases
  • 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
  • is clinically obvious
    
• posterior bleeding
  • present in around 10% of cases
  • 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
• sometimes involves large vessels resulting in sudden massive bleeding
• may be subtle or may present with an insidious onset as hematemesis, nausea, anaemia, haemoptysis or melaena
• more common in older patients

Reference

1. Mulla O, Prowse S, Sanders T, et al; Epistaxis. BMJ. 2012 Feb 23;344