Which of the following is a relative contraindication to nasal intubation?

• A. Basilar skull fracture
• B. Unconscious patient
• C. Nasal obstruction due to polyps
• D. Allergic reaction to local anesthetic

Answer: (A)

The key idea is that nasal intubation depends on passing a tube through the nasal passages toward the larynx, a route that sits close to the skull base. If there is a basilar skull fracture, the integrity of the skull base is compromised, so forcing a tube through the nasal route can risk penetrating into the cranial cavity or spreading infection from the nasopharynx into the meninges. That risk makes nasal intubation relatively contraindicated: it’s a situation where the dangers are significant enough to push you to choose an alternative airway method if possible. The other options don’t carry that same skull-base–related risk: being unconscious doesn’t prevent nasal intubation; a nasal obstruction from polyps creates a mechanical barrier to passage, which can make nasal intubation impractical; and an allergy to local anesthetic affects how you manage anesthesia rather than the safety of the nasal route itself. So basilar skull fracture stands out as the condition that most directly raises the risk of nasal intubation to a level that makes it relatively contraindicated.