Abstract
• In a consecutive forensic population (N = 1187), thyroid cartilage asymmetry was observed in 6.2 % of cases. • Asymmetry of the thyroid cartilage is more frequently observed in men and in older individuals. • Asymmetry of the thyroid cartilage is more frequently observed on the left side. • Asymmetry of the thyroid cartilage may be a consequence of prior trauma. This study is based on the hypothesis that occult cartilaginous fractures of the thyroid cartilage (TC) may result in asymmetry of the thyroid cartilage framework. Justification of this hypothesis was provided by an estimation of the prevalence of TC asymmetry based on a consecutive postmortem study group. The findings were then compared to three cases of nonfatal manual strangulation and one case of survival of blunt trauma to the neck. TC images from a consecutive two-year sample from the institutional postmortem computed tomography database (N= 1187) were assessed. Cases with acute TC injury were excluded. TC asymmetry, signs of prior TC trauma, sex and age, were retrieved. TC asymmetry was present in 72 cases (6.2%, 67 males). In 40 cases (3.5%), old TC fractures could be identified. The derived odds ratios were 7.48 for male sex and 1.02 for (each year of) age (p <0.001). Asymmetry of the TC laminae was observed significantly more often on the left side (N= 53, 73.6%, p <0.001). Cases 1 and 2 showed TC asymmetries following nonfatal manual strangulation. Cases 3 and 4 illustrated the limited visibility of cartilaginous fractures on computed tomography. TC asymmetry is associated with male sex and older age and is typically located on the left side. TC asymmetry in young and female cases is rare. TC asymmetry in young and/or female cases may result from occult cartilaginous fractures, as cases 1 and 2 indicated. Further research is needed to validate this hypothesis.
Highlights
The thyroid cartilage (TC), the largest single component of the larynx, is made up of two laminae, which join anteriorly to form the laryngeal prominence and have superior and inferior horns posteriorly
TC asymmetry is associated with male sex and older age and is typically located on the left side
TC asymmetry in young and/or female cases may result from occult cartilaginous fractures, as cases 1 and 2 indicated
Summary
The thyroid cartilage (TC), the largest single component of the larynx, is made up of two laminae, which join anteriorly to form the laryngeal prominence and have superior and inferior horns posteriorly. The male larynx and vocal cords grow significantly more than those in females during puberty, creating pronounced sexual dysmorphism [1]. The TC is subject to continuous ossification and calcification with increasing age, and this process is more pronounced in males than in females [1]. While incidental trauma to the TC is rare due to its protected location, targeted application of pressure to the neck is common in the forensic setting and is called manual strangulation (or ligature strangulation if a tool is used) [2]. Radiologic imaging is a helpful tool for the forensic interpretation of NFS. The application of magnetic resonance imaging has been investigated with mixed results [6-9]. The need for sharply defined findings for the evaluation of NFS remains
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