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. He described it as the naso-nasopharyngeal plexus.

Structure

Woodruff's plexus is located on the lateral wall of the nasal cavity below the posterior end of the inferior nasal concha. The plexus is of large thin-walled veins which lie in a thin mucosa.

Clinical significance

Bleeding

A nosebleed 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.
LocalSystemic

  • 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
    • A posterior source presents a greater risk of airway compromise, aspiration of blood, and greater difficulty in controlling bleeding.

    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.