Which airway adjunct is contraindicated in a patient with suspected skull fracture and CSF leakage from the nose or ears?

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

Answer: (A)

In suspected skull fracture with CSF leakage, using a nasal airway is contraindicated because the nasal route can channel the airway device through fracture lines into the cranial cavity, risking brain injury, pneumocephalus, or infection such as meningitis. The presence of CSF leakage already indicates a breach of the dura, so introducing anything via the nose could worsen the fracture, disrupt the intracranial space, or introduce nasal pathogens. The safer approaches are to secure the airway through the mouth (an oropharyngeal airway if the patient is unconscious and lacks a gag reflex) or to perform definitive airway management with an orotracheal intubation (or other oral-route airway as indicated) rather than a nasal route.