hi let's talk about the arteries that serve the nasal cavity so with respect to our discussion
we'll look first at the arteries serving the nasal septum and then we'll turn our attention
to the arteries serving the lateral nasal wall and what we'll see is that both of these walls
are served by basically the same three arteries so the arteries to keep in mind are going to be
branches of the ophthalmic artery superior ly the maxillary artery posterior lis and
the facial artery anteriorly so let's start with that ophthalmic artery ophthalmic artery as you
recall is a branch of the internal carotid that moves anteriorly across the orbit and it sends
two branches through the medial wall of the orbit and these are the posterior and anterior ethmoid
alar Therese so here we can see the posterior ethmoidal artery and it's continuation and here
is the anterior ethmoid Allari so we can see how these ophthalmic arteries are serving the septum
from the superior posteriorly so we're going to move clockwise posteriorly the sphenoid palatine
artery is going to serve the nasal septum through posterior septal branches the sphenopalatine
artery is a branch of the third part or the pterygopalatine part of the maxillary artery
so here we can see a posterior septal branch and this is anastomosis in with that posterior
ophthalmic there and it also continues on along the floor of the nasal cavity anteriorly so
there's our branches of the the maxillary or ultimately the the sphenopalatine artery
and then anteriorly we have nasal septal branches which come from the facial artery so if you recall
the superior labial branch of the facial artery is a very robust branch and it can send a branch up
towards the nose and that branch moving up towards the nose is the nasal septal artery and I can see
that moving that way so what we can't see here is a potential branch from the greater penalty
an artery we're not in the in the appropriate plane for that but that greater penalty an artery
can also serve the nasal cavity that way but one thing to really bring your attention to is that
we can see anastomosis between these arteries especially in this area so that's referred to
as Kiesel box area and it is the most frequent source of epistaxis or nosebleeds in the nasal
cavity over 90% of the cases of epic epistaxis occur from Kiesselbach's area so these are what
would be referred to as anterior bleeds and they are less serious than a posterior bleed which
would be coming from the lateral wall from this vena penalty an artery but these anterior bleeds
if you think about what's going on here this is an area that is very susceptible to drying out
through respiration through the nose and when that mucosa becomes very dry the vasculature there you
know is is likely to to micro hemorrhage and to produce a nosebleed so turning our attention to
the posterior wall I'm sorry that the lateral wall will see that all of the same players are involved
here so these are all going to be branches of the ophthalmic superiorly the maxillary posterior lis
and the facial anteriorly so let's see what we have so coming from the ophthalmic we're
going have our anterior ethmoidal artery supplying anterior lateral nasal branches we're also going
to have our posterior ethmoidal artery serving a posterior ethmoidal branch as well from the
maxillary artery here is sphenopalatine artery coming through and then giving rise to these
posterior lateral nasal arteries so there is a nice robust one moving along there that's great
and then there's another nice robust one moving along there so it's in this area that posterior
nosebleeds tend to originate and these while being the minority of cases so only about one
in ten cases or posterior nosebleeds they tend to be more serious because the maxillary artery
as one of the terminal branches of the external carotid artery has quite a bit of pressure behind
it and this is a difficult area to get to to apply pressure to so you know if necessary
a balloon tipped catheter can be inserted and then pressure can be applied to where the the
subpoena penalty an artery and these posterior lateral nasal arteries are originating and then
finally we have a lateral nasal that can make its way in through the the nose and these are
branches of the facial artery so the the lateral nasal branch is the branch immediately following
the superior labial branch so one branch up is the lateral nasal branch and some of those terminals
can make their way into the nasal cavity and so we have the the same pattern from the same
sources of arteries supplying the lateral wall as we did the nasal septum ophthalmic artery superior
maxillary artery posterior lis and facial artery anteriorly thank you very much for your time