Which skull fractures contraindicate nasal intubation?

Nasal intubation is generally contraindicated in patients with Le Fort II and III fractures due to the significant structural compromise of the midface and potential for associated injuries. Le Fort fractures involve the maxilla and can disrupt the facial skeleton, increasing the risk of airway trauma and complications if nasal intubation is attempted.

In these cases, the integrity of the nasal passages and surrounding structures is often compromised, which may result in the possibility of nasal bleeding or further displacement of the fractured bones during the intubation process. These fractures can also involve the orbital structures and the cranial cavity, thereby elevating the risk of introducing tools through a pathway that could cause further injury or infection. As a result, alternative intubation methods, such as oral or nasotracheal intubation, are preferred to maintain patient safety.

Other types of fractures, while potentially serious, do not carry the same level of immediate risk associated with nasal intubation as those seen in Le Fort II and III fractures.