classification of epistaxis

Last edited 07/2018 and last reviewed 03/2021

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)

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