Evaluation of hanging deaths in childhood: An autopsy study.

Fractures of the hyoid bone (HB) and thyroid cartilage (TC) are important findings in emergency medicine and forensic pathology. This study aimed to determine the occurrence and anatomical localization of HB and TC fractures and to evaluate the etiological and risk factors.A total of 315 patients with HB and/or TC fractures were included over a 3-year period. Data regarding the incident type, cause of death, age, sex, body mass index, regional trauma findings, location of fractures, resuscitation, and toxicological analyses were collected. Injury severity scores were calculated using the Abbreviated Injury Scale.The study found that HB and TC fractures were associated with trauma severity. The hanging cases exhibited the highest number of fractures. A significant association was observed between neck trauma localization and HB and TC fractures. Fractures of the HB and TC horns were more commonly associated with neck trauma than fractures of the corpus. Hyoid bone and TC fractures can occur without direct trauma, emphasizing the importance of thorough examination and diagnosis, particularly after cardiopulmonary resuscitation.This study provides valuable insights into HB and TC fractures and contributes to the understanding and identification of these fractures in forensic autopsies and clinical settings.

Hanging as a means to commit suicide is one of the most common methods known to mankind. But also, a common method to fabricate a murder. However, antemortem features at times are confirmatory but also confusing. This study aimed to establish the patterns of injuries to the neck structure in hanging cases. There were 228 cases of deaths caused by hanging. Hanging was most frequently reported in the 11-20 age group, comprising 30.22% (69 cases) out of 228 hanging deaths. Least seen among age group 81-90 i.e., 02 (0.87%). Above the age of 90, no deaths due to hanging were observed. Out of 228 deaths, 97 (42%) were females and 131 (57%) were males. Position of the knot was assessed, in 67 (29.3%) cases knots were on the left side of the neck, in 72 (31.5%) cases knots were on the back of the neck, in 75 (32.8%) cases knots were on right side of the neck and in 14 (6.14%) cases knots were found below the chin. Amongst all neck structure injuries, rupture/contusion of sternocleidomastoid and other strap muscles of the neck were found in 26.75% of cases. In 27.63% of cases, a carotid intimal tear was identified. Additionally, a hyoid bone fracture was observed in 1.75% of cases, and a thyroid cartilage fracture was present in 0.87% of cases. No injury to the cervical vertebra or cricoid cartilage was found.

Laryngeal injuries are rare but can be fatal. Depending on the type and severity of the trauma, thyroid and laryngeal cartilage fractures, full-thickness mucosal tears, tracheolaryngeal separation, and injuries leading to pneumomediastinum may be observed. Laryngeal traumas can occur either bluntly or penetratingly. Blunt traumas typically result from traffic accidents, falls, and sports injuries, while penetrating injuries are often caused by gunshot wounds or sharp objects. In this particular case study, the case was a 24-year-old male who was brought to the emergency room after being struck by a forklift at In his physical examination, a 10x1 cm wound was observed on his right scapula, along with subcutaneous emphysema in the subclavicular region. As a result of the examinations, the patient was found to have fractures of the larynx, thyroid cartilage, 8th rib and pneumomediastinum. In this study, it was thought that the thyroid and larynx cartilage fractures occurred as a result of hyperflexion/hyperextension of the neck without a direct blow to the neck region. This case is being presented because it is a rare occurrence in the literature, primarily due to its unique mechanism of injury.

Boyun bölgesine uygulanan mekanik kuvvetlere bağlı ölümlerle adli tıp uygulamalarında sıklıkla karşılaşılmaktadır. Bunlar arasında, en sık karşılaşılan adli ölüm olgu grubunu asılar oluşturmaktadır. Sık olmamakla birlikte bağla boğma olguları ile karşılaşılmaktadır. Bu çalışma adli tıp uzmanlarının sıklıkla karşılaştıkları ası ve bağla boğma olgularında ki boyun lezyonlanmn çeşitliliğini ve sıklığını göstermek, bunları literatür bilgileri ile tartışmak içinyapıldı. Adli Tıp Kurumu Adana Grup Başkanlığında otopsileri yapılan olgulara ait 2008-2009 yıllan kayıtları retrospektif olarak incelendi. 2726 olgu içerisinde boyun bölgesine mekanik kuvvet uygulanması (ası ve bağla boğma) sonucu öldüğü saptanan 159'u ası, 11 i bağla boğma olan 170 (%6.2) olgu çalışma kapsamına alındı. Olguların 104'ü (%61.2) erkek 66'sınm kadın olduğu, çalışma kapsamındaki toplam olguların %93.5'ini asıların, 6.5%'ini ise bağla boğmaların oluşturduğu, asıların tümünün intihar, bağla boğmaların ise cinayet olduğu görüldü. Olguların yaş aralıklarına bakıldığında 4 ile 86yaş arasında, en çok olgunun 37 (%21.7) ile 21-30 yaş aralığında olduğu, 32 olgunun 11 -20 yaş aralığında olduğu, 0-10 yaş aralığında ki iki olgunun kız çocuğu olduğu, bununda bağla boğma sonucu öldürüldüğü saptandı. Asıların 121'nin tipik lokalizasyonlu, 38'nin atipik lokalizasyonlu ası olduğu görüldü. Ası ve bağla boğmalarda 43(%25.3) olguda troid kıkırdakda kırık olduğu, 25(%14.7) olguda ise hyoid kemik kmğı olduğu, 11(%6.5) olgu da ise hem hyoid kemik hem de troid kıkırdakta birlikte kırık olduğu saptandı. 7 olguda servikal vertebrada kırık veya dislokasyon olduğu görüldü. Troid kıkırdak, hyoid kemik ve servikal vertebralarda bulgu veren olguların toplam 86(%50.6) olduğu görüldü.Anahtar kelimeler: Ası, bağla boğma, boyna bası, otopsi, adli tıp.

Background: Hanging is one of the common methods of asphyxial deaths. A gross and histopathological changes in skin and subcutaneous Tissues at ligature Site in cases of asphyxial deaths is helpful in making exact diagnosis of hanging and differentiating it from other form of asphyxia death like strangulation. Objective: To assess the importance of histopathological analysis of tissue underneath the ligature mark in cases of hanging and strangulation. Materials and Methods: The present study was done on medicolegal autopsies conducted at the department of Forensic Medicine and Toxicology, Maharaja Agarsen Medical College (MAMC), Agroha from 01.04.2022 to 31.03.2023 to study the gross and histopathological changes in neck structures. Results: During study period 32 cases were examined for gross and histopathological changes. In majority of the cases (93.75%), the ligature mark was present. The ligature mark was incompletely encircling the neck in 84.4% cases. The ligature mark was situated above the thyroid cartilage level in maximum 18 (56.3%) cases. On dissection of the neck, fracture of thyroid cartilage and fracture of hyoid bone was seen in 18.8% cases and 9.4% cases respectively. On the microscopic histopathological examination, congestion was the most common finding of the piece of ligature skin, comprising of 56.25% cases. Histopathological changes in carotid arteries were tear in tunica intima, tear in tunica media and congestion, which were found in 12.5% cases each.3.1% cases had tear of adventitia. Conclusion: The gross and histopathological changes in the skin and subcutaneous tissues at the ligature site in cases of asphyxial deaths can provide important information regarding the cause and manner of death. It is crucial to perform a detailed examination of the ligature site, internal structures of the neck along with microscopic examination to arrive at an accurate diagnosis and determine the circumstances surrounding the death.

The aims of this study were to determine the frequency of hyoid-laryngeal fractures in hanging in relation to the position of the ligature knot, to reconstruct the location of the ligature knot in cases of hanging when the furrow is not detectable on the skin, and to identify the possible mechanism of neck structure injuries. We report a retrospective autopsy study which included 557 cases of suicidal hanging: 413 men and 144 women, with an average age of 52.4 +/- 17.8 years. In 57.3% of them, hyoid-laryngeal fractures were found (average age was 54.3 +/- 16.5 years): 15.1% had only hyoid bone fracture, 26% had only thyroid cartilage fracture and 16.2% had both types of injury at the same time. Hyoid-laryngeal fractures were found more often in persons aged over 30 years. Hyoid bone fracture was a weak predictor of ligature knot position in our sample. Fracture frequencies of the thyroid cartilage show a statistically significant difference in relation to the ligature knot position among persons older than 30 years, which indicated the ipsilateral and posterior position of the knot. Absence or presence of any form of hyoid-laryngeal fracture indicated that knot position was anterior or posterior, respectively. The derived data would be useful for cases where the ligature has been removed from the body of the deceased shortly after hanging, where the noose is unavailable, and in cases where the ligature mark has faded such as with soft ligatures removed promptly or in decomposed bodies.

Introduction: Hanging is seen worldwide and is the most common method of suicide globally. Hanging in Western nations has been well documented. However, there appears to be a dearth of published data on hanging in Nigeria, Africa. The essence of this work is to look at the morphological characteristics and the epidemiological profile of victims who died from hanging. Materials and Methods: This was a 9-year retrospective autopsy study on hanging deaths from January 1, 2005, to December 31, 2013. The details of the injuries present were recorded in a predesigned format so as to minimize error. Such findings included age, sex, type of hanging, position of knot, number of turns of the ligature, and fracture of hyoid and thyroid cartilages. The findings noted were carefully compiled, tabulated, and analyzed using the Statistical Package for the Social Sciences version 20. Results: There were 22 cases of hanging during the study period representing 0.2% of the total autopsy cases. The mean age was 38 ± 12 years, ranging from 15 to 60 years. This was predominantly a male phenomenon, with males constituting 94.5%, whereas females accounted for only 4.5%. Hanging was most common in the fifth decade (27.3%). This was closely followed by the third and fourth decades. This study revealed that 95.5% had single loop. The knot was most common on the right representing 54.5% and least common at the occiput accounting for 13.6%. Hyoid bone fracture and thyroid cartilage fracture were seen in 22.7% each. Conclusion: This study has shown that the mean age of hanging was in the fourth decade in this environment, with an overwhelming male preponderance. Fixed single loop on the right side was the most common picture and a quarter had fracture of hyoid bone and thyroid cartilage. All the ligature marks were obliquely placed, and no fracture of cervical vertebrae was identified. A future study will be needed to determine what percentage of suicide is hanging in this part of the world.

Fractures of the hyoid bone and laryngeal cartilages in suicidal hanging

Background: Hanging signifies an asphyxiation form which, by a noose or another constricting bandtightened by body weight, is secondary to compression or restriction of the neck structures. All hangings aresuicidal. Accidental and homicidal hangings are rare and uncommon.Objective: This research was performed on deaths attributed to neck strain related to hanging andstrangulation carried out for post-mortem analysis in the mortuary of Osmania General HospitalMethods: Detailed information regarding the deceased and the circumstances of the death were collectedfrom the police and relatives by a questionnaire. For certain situations, the detail was matched by an on-siteobservation or by photos of the incident location.Results: Knot was present in the right side of the neck in 97(48.5%) cases, over the left side of the neckin 62(31%) cases, and over the center of the occipital region in 41(20.5%) cases. In the present study, it isobserved that in 167(83.5%) cases, the level of ligature mark was above the thyroid cartilage, below thethyroid cartilage in 11(5.5%) cases, and overriding the thyroid cartilage in 22(11%) cases. parchmentizationwas present in 135(67.5%) cases and absent 65(32.5%) cases. The causes for these observations are theligature material type and the length of suspension which in the majority of cases are parchmentized. 169cases (84.5%) did not show any changes around the ligature mark, but in 31 cases (15.5%). Fracture of hyoidbone was seen in 3.5% of the cases and fracture of thyroid cartilage was seen in 4.5% of the casesConclusion: Our society has a great socio-economic burden due to the high incidence of suicidal hangingamong young adults particularly women. The private essence of hanging and convenient access to ligaturepoints and ligature supplies renders suicide avoidance challenging. Marital disappointment, organic diseaseissues, and dowry abuse are the primary reasons behind suicide hanging.

Introduction: Asphyxia could occur in various situations like: Traumatic asphyxia, Hanging, Choking, Smothering, Strangulation, poisoning, etc. There are both external and internal general features to diagnose fatal asphyxia macroscopically such as: a) External (i) ligature mark (ii) congestion, cyanosis & petechial hemorrhages. b) Internal – fluidity of blood, dilatation of right chamber of heart and visceral congestion. Materials and Methods: An observational Cross sectional study was carried out in Department of Forensic Medicine & Toxicology, Santosh Medical College, Ghaziabad. A total 58 cases of fatal neck compression were included in this study during. All the cases with alleged history of fatal neck compression were included in the study, except where the dead body was severely decomposed, that would effect the observation of findings. In study the aim was to find out the different associated lesions, injuries / fracture of the organo-complex of the larynx, bleeds in the tongue, hemorrhage in the tonsils and tonsilar beds. Results: Majority cases of hanging were seen in young adult age group of 20 ± 30 years. The overall male : female ratio in cases of hanging was 11:1. Majority cases of hanging were suicidal. Neck compression and hanging were seen between time interval of 6 + AM to 12 noon. Congestion of the face was observed in 60.86%. Hemorrhage in Sub-conjunctiva, strap muscle, tongue, epiglottis and tonsil were seen in 13%, 23.91%, 13.04%, 20% and 15.21% cases respectively. Hyoid bone fracture was present in 13.04% while thyroid cartilage fracture was present in 4.34%. Conclusion: According to the present study hanging is more common in young adults mostly suicidal in nature. congestion of face is most significant external feature in hanging while tonsillar heamorrage is significant internal feature. Keywords: Hanging, Asphaxia, External neck injury, Internal neck injury, Ligature mark.

Ligature strangulation deaths in the province of Konya (Turkey)

Present retrospective study was carried out at the mortuary of J.L.N. Medical College, Ajmer from January 2015 to 31st December 2015. A total of 953 dead bodies were received for post-mortem examination during the study period. Out of them 49 cases were of Hanging The incidence rate of hanging is 5.14% (49 out of 953) in the present study with a male: female ratio of 3.9: 1 and 21–30 years age group being most commonly (46.93%) involved population. All 49 cases under the study were suicidal in nature no cases were of Homicidal Hanging. Personal reasons (22(44.89%)) and family problems (10(20.40%)%) were encountered to be the common reasons for committing suicide. Soft material 79.59%) was more commonly used as ligature than the hard one (20.40%). In these cases 47(95.91) were recovered completely hanging from a higher point (complete hanging), whereas only 2(4.08%) were recovered in kneeling down position or with toes or feet touching the ground (partial hanging); In 41 (83.67%) cases the lividity was noticed on back side.14(28.57%) victims (27.5%) presented with ecchymosis along the edges of the ligature mark because of violent movements at the terminal event. Discharge of semen was seen in08 (16.32%) cases whereas discharge of urine/faeces was noticed in 07 (14.28%) cases. La facie sympathetic and defence wounds were noticed in none of the cases under the study. On internal examination all 49 cases (100%) presented with white-glistening subcutaneous tissue and neck muscle no contusion was detected. In present study rupture of the strap muscles, fracture of thyroid cartilage or hyoid bone or tear in the intima of the carotid artery was not detected. The dribbling of saliva is considered as surest sign of ante-mortem hanging was noticed in only 36(73.46%)cases.

In compression of neck cases with faint or absent ligature mark on the neck and with minimal internal findings it may be difficult to opine about the cause and manner of death. Many times, in forensic practice, cases occur where there is allegation from maternal side of married woman particularly in cases of dowry deaths, where relatives claim that it is a case of post-mortem hanging. In such cases there is importance of clubbing the gross findings. These findings may be helpful in arriving at conclusions in such unsolved and doubtful cases. The present study was conducted in Department of Forensic Medicine and Toxicology of a Government Medical College and Hospital in year 2017. Total 2781 postmortem examinations were conducted in 2017. Out of that total 2781 cases, 176 compression of neck cases came for postmortem and amongst these 105 cases were studied in detail as per inclusion criteria. Out of 105 cases of compression around neck, which were studied, there were 93 cases of hanging, 10 cases of ligature strangulation, 01 case of manual strangulation and 01 case of accidental strangulation studied. Out of total 105 cases, 66 were males and 39 were females. In this study maximum cases of neck compression were observed in 21 to 30 years age group (30 cases). Intimal tear of carotid artery was observed in 11 cases of hanging and no carotid artery intimal tear was found in case of strangulation. In the present study, fracture of hyoid bone alone was found in total 11 cases of which 06 cases were in hanging, 05 cases were in strangulation. Fracture of thyroid cartilage was found in 03 cases of which 02 cases were of strangulation and 01 case of throttling. No case of cricoid cartilage fracture either alone or in combination to fracture of throat skeleton was observed in the present study.

Suicidal tendencies are increasing at an alarming rate all over the world. Hanging is one of the common method of committing suicide and is considered as a painless form of death. This prospective study was conducted among victims of hanging brought to Dr. B.R. Ambedkar medical college mortuary, Bengaluru during June 2016 to December 2016. A total of 118 cases of alleged hanging were selected for this prospective study. The pattern of hanging revealed from this study showed a male predominance. The maximum number of cases were in the 21 to 30 years age group. Overall the most common ligature material used for hanging was saree and dupatta. Hanging was typical in 06 cases (5.08%) and atypical in 112 cases (94.91%). Salivary dribble marks was seen in 29 (24.57%) cases and protrusion of tongue present in 37 (31.35%) cases. The direction of ligature mark was oblique in 105 (88.98%) cases and transverse in 13 (11.01%) cases. Ligature mark was above the thyroid cartilage in 92.37% cases and over the thyroid cartilage in 7.62% cases. Hyoid bone fracture was noted in 05 cases and thyroid cartilage fracture was seen in 01 case.

Out of 824 medico legal cases presenting to Dept. of Forensic Medicine, MGH, Khammam, TS during one year (November 2014 to October 2015), 32 (n=32) hanging cases were reported and all of them were taken into the present study. It was observed that the most vulnerable age group was 21 to 30 years [75.00%] in both sexes, with male to female ratio being 3:1. Males, Married, Hindu by religion, from rural area accounted for 71.87%. 24[75.00%] belonged to low income group. Preferred place of hanging was indoor setting in 31[96.81%] cases. Financial problem was the main cause of committing suicidal hanging. Marital unhappiness, chronic non-curable illness, domestic violence were the other main causative factors of hanging. Hanging was complete in 24[75.00%] and was atypical in 22 [68.75%] cases. Ligature material was present in 31 cases, it was above the level of thyroid cartilage in 28[87.50%], the ligature mark was oblique in 31[96.87%], deep in 26[81.25%]. Rope was used as ligature material by 24[75.00%]. Salivary discharge was observed in 14[43.75%] cases. Protrusion of tongue was seen in 12[37.50%]. Asphyxial signs and congestion of organs, soft tissue petechial hemorrhage was seen in 2 [6.25%], intimal tears of carotid artery in 4[12.50%]cases, fracture of hyoid bone in 7[2187%] cases and no thyroid cartilage fracture were seen. The study objective was to find out the epidemiological findings, pattern of hanging and identifying appropriate reasons