Which device is contraindicated in suspected basal skull fracture?

• A. Nasopharyngeal airway (NPA)
• B. Oropharyngeal airway (OPA)
• C. Endotracheal tube
• D. Laryngeal mask airway

Answer: (A)

Avoid nasal routes when a basal skull fracture is suspected. A nasopharyngeal airway passes through the nasal cavity into the pharynx, so if the skull base is fractured, this device can breach the fracture and enter the cranial cavity, risking brain injury, intracranial bleeding, or CSF leakage. The oropharyngeal airway stays in the mouth and is typically used when the patient is unconscious and lacks a protective gag reflex, avoiding the nasal passage entirely. If a definitive airway is needed, an oral endotracheal tube or a laryngeal mask airway can be used, as they do not require nasal insertion.