• endoscopy;
  • nasal;
  • CT;
  • paranasal sinuses

Disagreement exists over the vessels involved in posterior arterial epistaxis.

Woodruff’s plexus, on the lateral nasal wall inferior to the posterior end of the inferior turbinate, is frequently cited in the literature as the main site of posterior expistaxis.1,2[2  KAluskar S.K. (1996) Endoscopic approach to posterior epistaxis. ]

This research examined the importance of the plexus in two stages:

1.  Fifty consecutive adults with idiopathic posterior epistaxes cases were studied (28 men (56%), 22 women (46%), mean age 64 years). The site of bleeding was identified and endoscopically. Thirty-five (70%) bleeds arose from the septum and 12 (24%) from the lateral nasal wall (P  <  0.001, Binomial test). Septal bleeds arose with equal frequency from the upper and lower septum (36% and 34%, respectively). In three (6%) cases a bleeding point could not be found despite endoscopy. Only four (8%) bleeds came from the area of Woodruff’s plexus.

2.  Woodruff ’s plexus was studied in 16 cadaveric heads by anatomical microdissection. Histological analysis of 2112 H&E sections from six specimens was performed using high and low power light microscopy. This delineated the rich arterial supply to the posterior nasal cavity but revealed the vessels of Woodruff’s plexus to be exclusively venous in nature.

Thus the septal vasculature (posterior septal rami of the sphenopalatine artery) is the principal site of posterior epistaxis, an observation that may explain the reported efficacy of septal surgery for epistaxis. The existing literature over-emphasises the importance of Woodruff’s plexus and consequently, we recommend that clinicians examine the posterior septum in close detail as a first step in management.