The complication of intracranial placement of a nasogastric tube in patients with complex facial and skull base fractures is rarely seen. A case report of a patient with complex craniofacial injury after trauma in whom a computerized tomogram scan showed passage of a nasogastric tube via a fracture of the anterior cranial fossa floor into the skull vault is presented. This case stresses the caution to be exercised in the emergency room resusitation of patients with craniofacial injury requiring nasogastric tube placement.