An area on its front and lower part where four arteries meet, the source of most nosebleeds in children and young adults
Kiesselbach's plexus (Little's area) on the nasal septum
Anatomy · Head, neck & teeth
Nasal septum
The wall that divides the nose in two
Nose · midline partition of the nasal cavity
The thin midline partition that divides the nasal cavity into a right and a left chamber. Its front part is cartilage (the septal or quadrangular cartilage), and its back part is bone: the perpendicular plate of the ethmoid above and the vomer below. Both sides are covered with mucous membrane, and the richly supplied front part of the lining is the commonest source of nosebleeds.
How to spot them
- ▸A midline wall made of cartilage in front and two bones behind: the perpendicular plate of the ethmoid and the vomer
- ▸The quadrangular (septal) cartilage forms the front, mobile part and supports the bridge of the nose
- ▸Covered on both sides with mucous membrane, thickest and most vascular at the front
- ▸Rarely perfectly straight: some deviation is present in most adults
What to know
The plexus is fed by branches of the anterior ethmoidal, sphenopalatine, greater palatine and superior labial arteries
The four arteries of Kiesselbach's plexus — both the internal and the external carotid contribute
Its bony part is formed by a thin plate descended from the ethmoid bone above and a ploughshare-shaped bone below
The perpendicular plate of the ethmoid and the vomer (Latin for ploughshare)
A hole through it can result from repeated cautery, surgery or the snorting of cocaine, and can cause a whistling sound when breathing
Septal perforation
An operation to straighten it, when a bent partition blocks one side of the nose
Septoplasty, for a deviated nasal septum
The nasopalatine nerve runs obliquely down it to the roof of the mouth through the incisive canal
The nasopalatine nerve on the nasal septum, a branch of the maxillary nerve
Blood collecting between its cartilage and lining after a knock to the nose can block both nostrils and, untreated, destroy the cartilage
Septal haematoma — must be drained to prevent saddle-nose deformity
Key ideas
- In the nasal cycle, erectile tissue on the turbinates swells alternately on each side every few hours, but a bent septum makes the imbalance obvious.
- The septum is a junction of bones and cartilage that grow at different rates in childhood, one reason it is so seldom perfectly straight.
Quick-fire facts
- •Composed of the septal (quadrangular) cartilage, the perpendicular plate of the ethmoid and the vomer, with contributions from the maxillary and palatine crests below
- •Kiesselbach's plexus, named after Wilhelm Kiesselbach, is also called Little's area after James Leslie Little, who described it in 1879
- •Most nosebleeds arise from the front of the septum; posterior bleeds from Woodruff's plexus are commoner in older people
- •The nasopalatine nerve and the sphenopalatine artery descend on its surface
- •Some degree of deviation is found in up to about 80 per cent of people, but few need treatment
- •In some animals, an organ of smell for pheromones, the vomeronasal organ, lies at the base of the septum; in humans it is rudimentary
- •Nosebleeds are very common; NHS advice is to sit forward and pinch the nose just above the nostrils for 10 to 15 minutes
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Sources
- OpenStax, Anatomy and Physiology 2e — 22.1 Organs and Structures of the Respiratory System
- NHS — Nosebleed