Nose is richly supplied by both the external and internal carotid systems, both on the septum and the lateral walls.

NASAL SEPTUM

Internal Carotid System – Branches of Ophthalmic Artery

1. Anterior Ethmoidal Artery
2. Posterior Ethmoidal Artery

External Carotid System

1. Sphenopalatine artery (branch of maxillary artery) – nasopalatine and posterior medial nasal branches.
2. Septal branch of greater palatine artery (branch of maxillary artery)
3. Septal Branch of superior labial artery (branch of facial artery)

LATERAL WALL

Internal Carotid System – Branches of Ophthalmic Artery

1. Anterior Ethmoidal
2. Posterior Ethmoidal

External Carotid System

1. Posterior lateral nasal branches – From Sphenopalatine Artery
2. Greater Palatine Artery – From Maxillary Artery
3. Nasal branch of Anterior Superior Dental – From Infraorbital branch of Maxillary Artery
4. Branches of facial artery to nasal vestibule.

LITTLE’S AREA

Situated in the anterior inferior part of nasal septum, just above the vestibule.

Four arteries –

1. Anterior Ethmoidal
2. Septal Branch of Superior Labial
3. Septal Branch of Sphenopalatine and the Greater Palatine

All these anastomose here to form a vascular plexus called Kiesselbach’s Plexus.

This area is exposed to the drying effect of inspiratory current and to finger nail trauma, and is the usual site for epistaxis in children and young adults.

Retrocolumellar Vein

It runs vertically just behind the columella, crosses the floor of nose and joins venous plexus on the lateral nasal wall, common site of venous bleeding in young people.

WOODRUFF’S PLEXUS

It is a plexus of veins situated inferior to posterior end of inferior turbinate. Site of posterior epistaxis in adults.

Reference – Diseases of EAR, NOSE and Throat & Head and Neck Surgery,

PL Dhingra and Shruti Dhingra