Woodruff's plexus

Woodruff's plexus is a venous plexus located in the posterior part of the nasal cavity, near the posterior end of the inferior nasal concha. It is named after American otolaryngologist George Woodruff. This plexus is of clinical significance due to its role in epistaxis (nosebleeds), particularly those that are difficult to control and originate from the posterior part of the nasal cavity.

Anatomy

Woodruff's plexus is formed by the confluence of veins draining the posterior part of the nasal cavity. It is situated in a region known as the posterior nasal space, lying close to the sphenopalatine foramen, where the sphenopalatine artery enters the nasal cavity. The plexus is part of the rich vascular network of the nasal mucosa, which also includes the Kiesselbach's plexus located in the anterior part of the nasal septum.

Clinical Significance

The primary clinical significance of Woodruff's plexus lies in its association with posterior epistaxis. Unlike anterior nosebleeds, which are often minor and can be easily managed, posterior nosebleeds can be more severe, harder to control, and may require medical intervention. The plexus can become a source of significant blood loss due to its location and the density of the vascular network.

Epistaxis

Epistaxis, or nosebleed, is a common condition that can range from a minor annoyance to a life-threatening emergency. Posterior epistaxis, often involving Woodruff's plexus, tends to occur in older patients and can be exacerbated by hypertension, anticoagulation therapy, and certain systemic diseases. Management may require more complex interventions, including endoscopic cauterization, packing of the nasal cavity, or arterial ligation.

Management of Posterior Epistaxis

The management of posterior epistaxis involves initial attempts at conservative measures such as nasal packing. If these measures fail, further intervention may be necessary, including:

• Endoscopic Cauterization: Utilizing an endoscope to visualize and cauterize bleeding vessels directly.
• Arterial Ligation: Surgical ligation of the sphenopalatine artery, the anterior ethmoidal artery, or other feeding vessels may be required in severe cases.
• Embolization: In cases where surgery is not feasible or has failed, embolization of the feeding arteries by interventional radiology can be an effective treatment.

Prevention

Preventive measures for epistaxis, particularly in patients with a history of recurrent nosebleeds, include maintaining a humidified environment, nasal saline irrigation, and avoiding nasal trauma. In patients with identified risk factors, such as hypertension or those on anticoagulation therapy, careful management of these conditions is crucial.