ANATOMIC CONSIDERATIONS IN NASAL BONE FRACTURE PART II: Blood supply

The rich blood supply to the nasal region predisposes individuals to epistaxis in nasal trauma. Epistaxis can be categorized as anterior or posterior, depending on the source of bleeding. The most common location is anterior epistaxis, originating from Kiesselbach’s plexus in the anteroinferior septum, which receives its blood supply from both internal and external carotid arteries. Posterior epistaxis typically arises from branches of both the sphenopalatine and anterior ethmoidal arteries. It is less common than anterior bleeding but a more frequent cause of severe hemorrhage. Nasal hemorrhage can usually be controlled by direct manual pressure in anterior bleeds. Hemorrhage from posterior sources usually resolves spontaneously, particularly if the patient’s blood pressure is controlled. However, in persistent cases, posterior packing or Foley balloon catheterization of the nasal passage may be necessary. In the most severe cases, usually secondary to maxillary arterial sources, interventional embolization may be required. Both the ophthalmic and maxillary divisions of the trigeminal nerve supply sensation to the nose. The infratrochlear nerve provides sensation to the skin of the upper nasal dorsum and sidewalls, and the anterior ethmoidal supplies the lower dorsum and tip.