An unusual complete laryngo-tracheal separation in a suicidal hanging with a drop effect

Abstract

Case report A 48-year-old man was found in a public garage, having committed suicide by hanging. The rope which he used as ligature was fixed to the garage’s iron fence. The hanging was complete, with a recorded drop of 2‐2.5 m. An autopsy was performed the following day. The deceased was 186 cm tall and weighed approximately 90 kg. The 2 cm wide rope had compressed the neck to approximately 9.5 cm in diameter. The fixed ligature knot was on the posterior area of the neck as in a typical hanging (Fig. 1a), while the loop was below the laryngeal protuberance. After removing the noose a deep, wide strangulation mark was clearly visible (Fig. 1b). Subsequent dissection of the layers of skin and soft tissue of the neck revealed slight bilateral symmetrical hemorrhages at the periosteal-clavicular origin of the sternocleidomastoid muscles, a complete separation of the larynx from the trachea to the cricotracheal ligament, where part of the esophagus (Fig. 2) and a partially fractured anterior part of the cricoid cartilage were clearly visible, and Amussat’s sign (bilateral superficial transverse lacerations in the intimal layer of the carotid arteries visible below its bifurcation) (Fig. 3a, b). No fractures of the hyoid bone, thyroid cartilage, or cervical spine were found. In the region of the lumbar spine, Simon’s sign (hemorrhages beneath the anterior longitudinal ligament) was also present. Other major autopsy findings were consistent with a rapid death. The victim’s blood alcohol concentration was found to be 0.63 g/l. The cause of death was attributed to severe air-way injury due to hanging; i.e. a complete laryngo-tracheal separation.