A nasopharyngeal airway is contraindicated in which scenario?

• A. Suspected basal skull fracture or severe facial trauma
• B. Nasal obstruction
• C. Mild facial swelling
• D. Unconscious with no gag reflex

Answer: (A)

The main idea here is that a nasopharyngeal airway passes through the nasal passage into the pharynx, and its use relies on the nasal route being safe. When there is a suspected basal skull fracture or severe facial trauma, inserting this airway can drive the tip into the skull base or worsen fractures, potentially causing brain injury or a CSF leak. That risk makes it a clear contraindication in those scenarios.

In other situations, the device is more acceptable: nasal obstruction makes placement difficult or impossible but isn’t as dangerous, mild facial swelling doesn’t by itself prevent use, and an unconscious patient with no gag reflex is exactly when a nasopharyngeal airway is often appropriate because it avoids triggering a gag and helps maintain a patent airway.