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Injuries To Neck Structures in Deaths Due To Constriction of Neck, With A Special Reference To Hanging
Injuries To Neck Structures in Deaths Due To Constriction of Neck, With A Special Reference To Hanging
com
J O U R N A L
O F
FORENSIC
A N D L E G AL
ME D IC IN E
Journal of Forensic and Legal Medicine 15 (2008) 298305
www.elsevier.com/jflm
Original Communication
Abstract
This prospective study aimed at examining various injuries to the neck structures in deaths due to constriction of neck. Neck dissection technique, as advocated by Prinsloo and Gordon was undertaken to study the injuries to the thyro-hyoid complex, strap muscles,
carotid vessels, etc.
Of the 1746 medico-legal autopsies, conducted during the study period, 5% were deaths due asphyxia of which 82% were those of
constriction of neck. The 2130 years age group accounted for the maximum number of cases (57%). Male:female ratio was 2:1. Hanging
(69%) outnumbered other asphyxial deaths ligature and/or manual strangulation, smothering, etc. Injury to the sternocleido-mastoid
muscle (54%) was the commonest injury to the neck structures. The hyoid bone was fractured in 21% cases, while the thyroid cartilage
was fractured in 17% cases. Complete hanging was noted in 68% of cases while the hanging was atypical in 88%. Fixed knot was found to
have been used in 71%. A single loop round the neck was observed in 80% of the cases and it was above the level of thyroid in 58% cases.
Most cases of the fracture of the laryngo-hyoid complex were in the 4160 year age group, 72% and the fracture was on the same side as
the knot in 52% cases. Majority used soft daily wear articles of clothing like a sari (32%) or chunni (24%).
Asphyxial deaths due to constriction of neck being common in all parts of the world, prospective studies in dierent setups to examine
the prole of neck structure injuries are needed so as to dierentiate the suicidal or homicidal nature of such deaths with a greater
certainty.
2008 Elsevier Ltd and FFLM. All rights reserved.
Keywords: Asphyxia; Asphyxial deaths; Hanging; Strangulation; Ligature; Laryngo-hyoid complex; Medico-legal autopsy
1. Introduction
The term asphyxia literally means defective aeration of
blood due to any cause. Bacroft1 using the term anoxia
divided the condition into three groups: (1) anoxic anoxia
meaning prevention of oxygen from reaching the lungs,
(2) anemic anoxia meaning inability of blood to carry sufcient oxygen to the tissues due low hemoglobin content,
and (3) stagnant anoxia meaning lack of oxygenated
*
Corresponding author.
E-mail address: [email protected] (B.R. Sharma).
1752-928X/$ - see front matter 2008 Elsevier Ltd and FFLM. All rights reserved.
doi:10.1016/j.jm.2007.12.002
B.R. Sharma et al. / Journal of Forensic and Legal Medicine 15 (2008) 298305
299
300
B.R. Sharma et al. / Journal of Forensic and Legal Medicine 15 (2008) 298305
Different Types of Asphyxial Deaths
50
46
Males
45
Females
40
35
30
25
20
20
15
11
10
6
0
Hanging
Ligature Strangulation
Throttling
Drowning
Suffocation
traumatic Asphyxia
Males
25
Females
24
20
15
14
11
10
9
7
5
4
3
2
1
<15 years
16-20 years
21-25 years
26-30 years
31-40 years
41-50 years
51-60 years
>60 years
tion, two (67%) and right greater horn in cases of throttling, two (67%) (Table 1).
Among the injuries to the thyroid cartilage, bruising of
the capsule was found in seven (11%) cases of hanging
and four (100%) cases of throttling while both bruising of
the capsule in association with the fracture of the body
were found in four (50%) cases of ligature strangulation.
Fracture of the body of thyroid cartilage was found in
six (9%) cases of hanging and three (75%) cases of throttling (Table 1).
Overall, 45 (68%) cases were of complete hanging and 58
(88%) cases were of atypical hanging (suspension point
being at a place other than the nape of neck, as against
B.R. Sharma et al. / Journal of Forensic and Legal Medicine 15 (2008) 298305
301
Table 1
Neck structure injuries in cases of compression of neck
Neck structure injuries
Compression of neck
Hanging (n = 66)
Throttling (n = 04)
Total (n = 78)
No.
No.
No.
No.
10
8
6
9
8
15.2
12.1
9.1
14.1
12.1
3
2
1
0
0
37.5
25.0
12.5
0
0
3
1
2
1
0
75.0
25.0
50.0
25.0
0
16
11
9
10
8
20.5
14.1
11.5
12.8
10.3
6
2
7
9.1
3.0
10.6
4
1
4
50.0
12.5
50.0
3
2
4
75.0
50.0
100.0
13
5
15
16.7
6.4
19.2
28
6
28
42.4
9.1
42.4
4
2
0
50.0
25.0
0
1
0
0
25.0
0
0
33
8
28
42.3
10.3
35.9
Table 2
Neck structure injuries in dierent types of hanging
Neck structure injuries
Types of hanging
Typical complete
(n = 05)
No.
Typical incomplete
(n = 03)
No.
1
1
0
1
0
2
0
0
1
2
5
4
5
5
4
2
2
1
2
2
10
7
6
9
8
1
0
1
0
0
0
5
1
4
1
1
1
7
2
6
3
0
0
1
0
3
16
6
7
8
2
18
28
8
28
Atypical complete
(n = 40)
No.
Atypical incomplete
(n = 18)
No.
Total
(n = 66)
No.
302
B.R. Sharma et al. / Journal of Forensic and Legal Medicine 15 (2008) 298305
Ligature Material Used
16
Males
14
14
females
13
12
10
9
8
7
4
3
2
0
Chunni
Sari
Pajama/Pant
Rope
Electric Cable
Table 3
Relationship of the type of knot to the position of the knot and the type of hanging
Position of the knot
Total (n = 66)
No.
No.
3
4
5
7
15.8
21.0
26.3
36.8
7
12
16
12
14.9
25.5
34.0
25.5
10
16
21
19
15.2
24.2
31.8
28.8
11
5
3
57.9
26.3
15.8
27
13
7
57.5
27.7
14.9
38
18
10
57.6
27.3
15.2
Type of hanging
Typical complete
Typical incomplete
Atypical complete
Atypical incomplete
3
0
15
1
15.8
0
79.0
5.3
2
3
25
17
4.3
6.4
53.2
36.2
5
3
40
18
7.8
4.5
60.6
27.3
B.R. Sharma et al. / Journal of Forensic and Legal Medicine 15 (2008) 298305
Table 4
Particulars of laryngo-hyoid complex fractures
Particulars
No.
Age in years
<20
2140
4160
>61
Total
0
4
18
3
25
0
16.0
72.0
12.0
100 (32.0)
Sex
Male
Female
18
7
72.0
28.0
13
10
2
52.0
40.0
08.0
Structures involved
Thyroid cartilage
Hyoid bone
Thyroidhyoid combined
9
12
4
36.0
48.0
16.0
303
304
B.R. Sharma et al. / Journal of Forensic and Legal Medicine 15 (2008) 298305
importance, even in the case of hanging supposed to be suicidal, with the aim of ascertaining the antemortem character of the lesion and the physio-pathological mechanism of
death and to exclude the possibility of murder dissimulation. Furthermore, the ligature mark being mainly a postmortem phenomenon, any inner neck structure injury
indicating ligature mark intravitality is to be identied to
establish the antemortem hanging. However, a critical
analysis of the postmortem diagnostic criteria for asphyxia
leads to a diculty that has signicant implications for the
forensic pathologist. The diculty is that there are no universally recognized pathognomic signs of asphyxia and the
pathologists frequently make this diagnosis based on
observations that individually have indeterminate signicance but combined together, in the appropriate context,
have diagnostic value. Still-further, the signs of strangulation form a spectrum of degree from minimal to marked
and there is no consensus as to the minimal number and
nature of lesions that is required to make the diagnosis of
strangulation. There are occasions when the injury to the
neck structures caused by hanging or ligature strangulation
may become dicult to appreciate for the doctor conducting autopsy and as such there is need for studies in dierent
setups to examine the prole of neck structure injuries so as
to dierentiate the suicidal or homicidal nature of such
deaths with a greater certainty.
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