Epistaxis pathophysiology

Nosebleeding occurs due to tears in the mucosal lining and the many small blood vessels it contains. Fragility or injury may cause the tears, while inflammation, coagulation problems and other disorders may make the injury more difficult to repair. In some patients, rupture of nasal blood vessels is spontaneous.

Different causes tear vessels of the nose plexuses and lead to epistaxis:^[1]

• Epistaxis results from tears in the nasal mucosal lining, which contains many small blood vessels. It can be started by trauma, nasal picking, coagulopathies, and tumors.
• There is not enough evidence that hypertension is a risk factor for epistaxis. The technique of lowering blood pressure to control and prevent epistaxis remains controversial.
• Anterior epistaxis is more common, and the source of this bleeding is usually Kiesselbach’s plexus.
• Posterior bleeding is less common and harder to stop, and the source of this bleeding is usually Woodruff’s plexus. Bleeding from this plexus may cause aspiration and lead to bleeding with coughing and hemoptysis, as it generates a greater flow of blood. Posterior bleeding can compromise the airway if blood leaks into the posterior pharynx.^[2]

Location of the Kiesselbach’s and Woodruff’s plexus^[3]

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