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 is of large thin-walled veins which lie in a thin mucosa.[4]

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.[5]

Risk factors for nosebleed in Woodruff's plexus
Local Systemic

A posterior source presents a greater risk of airway compromise, aspiration of blood, and greater difficulty in controlling bleeding.[6][7]

Treatment

Posterior nasal packing is needed for posterior epistaxis.

Posterior nasal packing

Its required for patients bleeding posteriorly into the throat. A postnasal pack is first prepared by tying three silk ties to a piece of gauze rolled into the shape of cone. A rubber catheter is passed through the nose and its end brought out from the mouth. Ends of the silk threads tied to it and catheter withdrawal from nose. Pack which follows the silk thread, is now guided into nasopharynx with the index finger. Anterior nasal cavity is now packed and silk thread tied over the dental roll. The third silk thread is cut shorts and allowed to hang in the oropharynx, it helps in easy removal of the pack later. Patient requires postnasal pack should always be hospitalized.

Foley's catheter of size 12-14F can also be used to prevent posterior epistaxis. After insertion balloon is inflated with 5-10 ml of saline. The bulb is inflated with saline and pulled forward so that choana is blocked and then an anterior nasal balloons are also available. A nasal balloons has 2 bulbs, one for post nasal space and the other for nasal cavity.

Endoscopic cautery

Posterior bleeding point can sometimes be better located with an endoscope. It can be coagulated with the cautery. Local anesthesia with sedation may be required.

Ligation of vessels

Ligation of this is done in uncontrollable posterior epistaxis. Approach is Caldwell-luc operation. Posterior wall of the maxillary sinus is removed and the maxillary artery or its branch are blocked by applying clips.[8]

References
  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.
  2. Gleeson, edited by Michael (2008). Scott-Brown's otolaryngology, head and neck surgery (7th ed.). London: Hodder Arnold. ISBN 978-0340808931.CS1 maint: extra text: authors list (link)
  3. "Woodruff plexus". radiopaedia.org. Retrieved 18 July 2019.
  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.
  5. Seiden, ed. by Allen M. (2002). Otolaryngology : the essentials (1st ed.). New York [u.a.]: Thieme. ISBN 9780865778542.CS1 maint: extra text: authors list (link)
  6. http://www.medicalgrapevineasia.com/mg/2014/06/10/getting-to-the-flow-of-epistaxis/. Missing or empty |title= (help)
  7. Corry J. Kucik; Timothy Clenney (January 15, 2005). "Management of Epistaxis". American Family Physician. American Academy of Family Physicians. 71 (2): 305–311. Retrieved 18 July 2019.
  8. Dhingra, P.L (2013-10-01). Diseases of Ear, Nose and Throat & Head and Neck Surgery (6th ed.). Elsevier. ISBN 978-8131234310.
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