Woodruff's plexus

Woodruff's plexus was discovered by George H. Woodruff in 1949. The plexus is located below the posterior end of the inferior concha, on the lateral wall of the nasal cavity.^[1]^[2]^[3] He described it as the naso-nasopharyngeal plexus.^[1]

Structure

Woodruff's plexus is located on the lateral wall of the nasal cavity below the posterior end of the inferior nasal concha (turbinate).^[3] The plexus contains both arteries and veins which lie in a thin mucosa.^[4] The major arteries supplying the plexus are the sphenopalatine artery and ascending pharyngeal artery.^[5] The internal maxillary vein is also within the plexus.

Clinical significance

Bleeding

A nosebleed (epistaxis) usually occurs in the anterior part of the nose from an area known as Kiesselbach's plexus which consists of arteries. Woodruff's plexus is a venous plexus in the posterior part and a nosebleed here accounts for only between 5 and 10 per cent of nosebleeds. Older adults are most often affected.^[6]

Risk factors for nosebleed in Woodruff's plexus
Local	Systemic
Trauma Sinusitis and allergies Surgeries	Hypertension Deficiency in clotting factors Immunodeficiency Anticoagulants such as warfarin and aspirin Thrombocytopenia Liver or kidney failure and vitamin C deficiency

^[7]

Treatment

Posterior nasal packing is needed for posterior epistaxis.

References

^ ^a ^b Woodruff, GH (November 1949). "Cardiovascular epistaxis and the naso-nasopharyngeal plexus". The Laryngoscope. 59 (11): 1238–47. doi:10.1288/00005537-194911000-00003. PMID 15394264. S2CID 43177792.
^ Gleeson, Michael, ed. (2008). Scott-Brown's otolaryngology, head and neck surgery (7th ed.). London: Hodder Arnold. ISBN 978-0340808931.
^ ^a ^b "Woodruff plexus". radiopaedia.org. Retrieved 18 July 2019.
^ Chiu, TW; Shaw-Dunn, J; McGarry, GW (October 2008). "Woodruff's plexus". The Journal of Laryngology and Otology. 122 (10): 1074–7. doi:10.1017/S002221510800176X. PMID 18289456. S2CID 2866097.
^ "Epistaxis | Iowa Head and Neck Protocols". medicine.uiowa.edu. Retrieved 2025-02-06.
^ Seiden, Allen M., ed. (2002). Otolaryngology : the essentials (1st ed.). New York [u.a.]: Thieme. ISBN 9780865778542.
^ Corry J. Kucik; Timothy Clenney (January 15, 2005). "Management of Epistaxis". American Family Physician. 71 (2). American Academy of Family Physicians: 305–311. PMID 15686301. Archived from the original on 29 August 2008. Retrieved 18 July 2019.

[Woodruff-1] Woodruff, GH (November 1949). "Cardiovascular epistaxis and the naso-nasopharyngeal plexus". The Laryngoscope. 59 (11): 1238–47. doi:10.1288/00005537-194911000-00003. PMID 15394264. S2CID 43177792.

[Gleeson-2] Gleeson, Michael, ed. (2008). Scott-Brown's otolaryngology, head and neck surgery (7th ed.). London: Hodder Arnold. ISBN 978-0340808931.

[radiopaedia-3] "Woodruff plexus". radiopaedia.org. Retrieved 18 July 2019.

[Chiu-4] Chiu, TW; Shaw-Dunn, J; McGarry, GW (October 2008). "Woodruff's plexus". The Journal of Laryngology and Otology. 122 (10): 1074–7. doi:10.1017/S002221510800176X. PMID 18289456. S2CID 2866097.

[5] "Epistaxis | Iowa Head and Neck Protocols". medicine.uiowa.edu. Retrieved 2025-02-06.

[6] Seiden, Allen M., ed. (2002). Otolaryngology : the essentials (1st ed.). New York [u.a.]: Thieme. ISBN 9780865778542.

[Kucik-7] Corry J. Kucik; Timothy Clenney (January 15, 2005). "Management of Epistaxis". American Family Physician. 71 (2). American Academy of Family Physicians: 305–311. PMID 15686301. Archived from the original on 29 August 2008. Retrieved 18 July 2019.

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