Which airway adjunct is contraindicated with basal skull fracture?

• A. Oropharyngeal airway.
• B. Endotracheal tube.
• C. Nasopharyngeal airway.
• D. Laryngeal mask airway.

Answer: (C)

When there’s suspicion of a basal skull fracture, nasal routes are avoided because they can breach the skull base. The nasopharyngeal airway sits in the nose and passes toward the back of the throat, and if a fracture is present, it can be driven into the cranial cavity, causing intracranial injury or infection. That risk makes the nasopharyngeal airway contraindicated. In this situation, an oropharyngeal airway can be used if the patient is unconscious and has no gag reflex, and definitive airway management with an endotracheal tube is preferred to protect the airway and prevent aspiration. A laryngeal mask airway might be used as a temporary measure in some cases, but it does not provide the same level of airway protection as an endotracheal tube.