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Woodruff's plexus Revisited
Dr. T. Balasubramanian M.S. D.L.O.
Woodruff in 1949 reported a group of large blood vessels in the lateral wall of inferior meatus posteriorly. He was able to visualize these blood vessels using a rigid nasopharyngoscope. He coined the term "Naso nasopharyngeal plexus" to describe these vessels. He suspected the association between the presence of these dilated blood vessels and posterior epistaxis. He was not sure whether these vessels are veins or arteries.
Microdissection studies revealed a superficial collection of fragile fairly large calibre blood vessels lying just beneath the surface mucosa. There was very little intervening connective tissue. Histological studies revealed that the epithelium overlying the posterior inferior meatus was typical respiratory epithelium. The blood vessels in this area were sinus like with very little muscle or fibrous tissue within their walls. The average blood vessel diameter in this area is 1-2mm.
Shaheen described Woodruff's plexus as an arterial plexus formed by anastomosis between pharyngeal, posterior nasal, sphenopalatine and posterior septal arteries. Microdissection and histological studies have proved Woodruff's plexus to be venous in origin.
Bleeding from the blood vessels of Woodruff's plexus could result in a slow but prolonged ooze. Since these blood vessels have no muscle walls, hemostasis is poor. Post nasal packing will have to be resorted to in rare cases to stop bleeding.