Macroscopic Neck Findings in Asphyxial Deaths Due to Hanging and Strangulation with Special Reference to the Hyoid Bone at Police Morgue Autopsies

Introduction: Asphyxial deaths from strangling or hanging are most commonly caused by neck lesions associated with laryngohyoid fractures. Therefore, it is unclear if these clinical characteristics are important for diagnosing the asphyxia mode. Aims: This study aims to compare macroscopic neck findings in asphyxial deaths due to hanging and strangulation, focusing on hyoid bone fractures. It evaluates their frequency and patterns to aid in determining the manner of death, supporting accurate differentiation between suicidal, homicidal, and accidental asphyxia in forensic investigations. Materials and Methods: For this observational cross-sectional investigation, asphyxial death cases from hanging or strangling were collected between July 2022 and December 2023. While autopsy records were used to include cases, decomposed or mangled remains and other types of asphyxia were excluded. The sample size was calculated using Solvin's technique, and statistical analysis was performed using GraphPad Prism software version 8. Results: The most common method among the 100 instances was hanging (n=83), which was followed by throttling (n=3), partial hanging (n=5), and strangulation (n=9). 26% of instances had abrasions, whereas 69% showed none at all. Most of the knots were placed over the left mastoid (56%), followed by the right mastoid (17%) and the occipital bone 7%. Seventy-seven percent of the deceased in the hanging cases had a high level of ligature material. Grooved ligature marks were significantly more common in hanging victims than in strangulated victims (56% vs. 1%, p<0.0001), and they were most common in victims aged 41–50 years (p=0.91). 19% of hanging and strangulation instances had abrasions, compared to 77% (p<0.0001), 37.5% of strangling victims had damaged skin, but 59% of hanging victims had dry skin beneath the ligature (p < 0.0001). Conclusion: By pointing up significant variations in outcomes between hanging and strangling fatalities, this study enhances forensic assessments and highlights the importance of thorough autopsy.