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Nasal cavity, septum and Kiesselbach's plexus

  • Applied anatomy

Each nasal cavity has a septum in the middle and three turbinates on the side; most nosebleeds come from a vessel network at the front of the septum.

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See it in 3D: Nasal cavity · Nasal septum · Inferior nasal conchae

What it is

The nasal cavity is divided by the septum and shaped on each side by three conchae (turbinates) with a meatus under each. The front of the septum carries Kiesselbach's plexus (Little's area), where several arteries meet just under thin mucosa: this is where about 90% of nosebleeds start, within reach of pressure and cautery. Knowing what drains into each meatus, where smell lives and how the septum is built explains epistaxis, nasal blockage, septal haematoma and loss of smell.

Applied anatomy

  • Septum: septal cartilage (anterior), perpendicular plate of the ethmoid and vomer (posterior).
  • Lateral wall: superior and middle conchae (parts of the ethmoid) and the inferior concha (a separate bone), with a meatus under each.
  • Inferior meatus: opening of the nasolacrimal duct.
  • Middle meatus: drainage of the frontal, maxillary and anterior ethmoid sinuses (ostiomeatal complex).
  • Superior meatus: posterior ethmoid cells; sphenoethmoidal recess: sphenoid sinus.
  • Olfactory epithelium: roof of the nasal cavity, under the cribriform plate of the ethmoid.

Clinical physiology

  • Turbinates enlarge the surface and make airflow turbulent so air is warmed, moistened and filtered.
  • Respiratory mucosa (ciliated epithelium with goblet cells) traps particles in mucus and moves it back to the throat.

Clinical correlation

  • Common triggers of anterior epistaxis: nose picking, dry or cold air, colds and allergies, nasal sprays and oxygen by cannula.
  • Recurrent nosebleeds may point to hypertension, a bleeding disorder, anticoagulant or antiplatelet use, or a nasal or sinus tumour.
  • A deviated septum causes fixed one-sided blockage and can block sinus drainage.
  • Unilateral blockage with bloody discharge in an adult is a red flag for a tumour.

Next step / Initial management

  • Anterior rhinoscopy with a good light: look at Little's area, the septum (deviation, haematoma, perforation) and the inferior turbinate.
  • Active anterior bleed: patient sitting and leaning forward, firm pressure on the soft part of the nose for a full 10 minutes; then topical vasoconstrictor and cautery of a visible vessel.
  • Refer to the emergency department (same day) if bleeding lasts more than 20 minutes despite pressure, seems posterior, follows head or facial trauma, or occurs on anticoagulants with instability.
  • Suspected septal haematoma after trauma: same-day referral for drainage.
  • Refer routinely to ENT for recurrent nosebleeds, one-sided blockage or bloody discharge, or a fixed deviated septum with symptoms.

Test yourself

Think of the answer, then tap the question to see it.

Where do about 90% of nosebleeds start, and why there?

In Kiesselbach's plexus (Little's area) on the anterior inferior septum, where several arteries join under thin, exposed mucosa.

A boy has a painful, blocked nose two days after a fall; both sides of the septum bulge and feel soft. What is the risk if left alone?

Septal haematoma: without prompt drainage the cartilage can die, forming an abscess or a permanent deformity that blocks the nose. Same-day referral.

Into which meatus does the nasolacrimal duct open?

The inferior meatus, under the inferior turbinate.

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Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.

Sources: Anatomy, Head and Neck, Nasal Cavity (StatPearls (NCBI Bookshelf), 2023); Nosebleed (MedlinePlus, US National Library of Medicine, 2025); Nose fracture (MedlinePlus, US National Library of Medicine, 2024); Smell Disorders (National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, 2023).

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