A study of injuries to neck structures in cases of hanging

INTRODUCTION : Hanging remains to be one of the common methods of committing suicide. Homicidal and accidental hanging are rare. Hence all cases of hanging are considered as suicidal until the contrary is proved. Because of the above, postmortem suspension of the body may be resorted to mask the crime. So, a careful forensic examination is of great importance, with the aim of ascertaining the antemortem character of the lesion and also to exclude the possibility of murder dissimulation. There is no specific gold standard to distinguish between Antemortem hanging and Postmortem hanging. However presence of : 1) Vertical salivary dribble mark from the dependant angle of mouth 2) The phenomenon of Lefacies sympathetique 3) Presence of Petechial haemorrhages 4) Hyperaemia and ecchymosis of margins of ligature mark are considered as features of antemortem hanging. But obvious salivary dribble mark could be detected only in 56% of cases. A meticulous examination of the body right at the scene of hanging, that too, before removing the clothes and apparels can give the real prevelance of it. Lefacie sympathetique is very rare, i.e., as low as 1% as observed in different studies. Although petechial haemorrhages commonly occur in cases of antemortem hanging, they are not diagnostic of antemortem hanging and they occur in various asphyxial and nonasphyxial deaths. And it is also equally important to note that petechiae may be absent in rapid death due to vagal stimulation in hanging. So, petechial haemorrhages cannot be taken as a specific feature of antemortem hanging. Furthermore, the ligature mark, which is considered as the principal external sign of hanging, is mainly a postmortem phenomenon. So, it is very much necessary to look for any injury to inner neck structures, that is quiet frequent than the above, which cannot be artificially produced and which also indicates ligature mark intravitality to establish the antemortem hanging. AIM : The aim of this prospective study, done during the period of August 2008 to July 2009, at the Department of Forensic Medicine, Government General Hospital, Madras Medical College, Chennai-3, in cases of deaths due to hanging, is to determine the prevalence of neck injuries like, 1. Rupture/contusion of sternomastoid and strap musles of neck, 2. Carotid intimal tear, 3. Fracture of hyoid bone, 4. Fracture of thyroid cartilage, 5. Fracture of cricoid cartilage, 6. Fracture and dislocation of cervical vertebra and To find out, the most common and most reliable criteria of neck injury, to say, that it is an antemortem hanging. MATERIAL AND METHODS : This prospective study was conducted in the Institute of Forensic Medicine, at Madras Medical college and Government General Hospital, Chennai-3, from August 2008 to july 2009. Only cases in which the history and scene of crime examination report given by police and relatives of the deceased are suggestive of Antemortem hanging were included. 63 cases of deaths due to hanging, which was subjected to Medicolegal Autopsy, were the subjects of this study. All cases with, 1. External neck injuries other than the ligature mark, 2. Other external injuries suggestive of homicide, and 3. Cases with postmortem interval of more than 24hrs to avoid artifacts of decomposition were excluded. The information regarding identification of the deceased, reason for committing suicide, place of hanging, material used, position of the knot, type of knot, whether it was a complete or partial hanging, any blood stains or disturbance, etc., at the scene of crime, to rule out the possibility of homicide, history of any illness or drug intake, alcoholism, previous attempt of suicide, presence of suicidal note, etc were enquired from the police and detailed interviews of the relatives of the deceased. Irrespective of the information gathered from the police records and accompanying relatives of the deceased, in all cases, both external and internal findings were observed meticulously during postmortem examination to rule out homicidal hanging or any other cause of death. Complete perusal of all the records done prior to Medicolegal Autopsy, which is a routine protocol in all cases. CONCLUSION : A prospective study of deaths due to hanging was done during the period of August 2008 to July 2009, from the medicolegal autopsies conducted at the Institute of Forensic Medicine, Madras Medical College Hospital, Chennai-3. During that period, there were 63 deaths due to hanging. From this study, the following conclusions could be drawn: 1. Most of the deaths due to hanging were in the age group of 20-30yrs (38%). 2. Incidence of hanging was slightly more in males (56%) when compare to females. 3. Place of hanging being in their own residence in all the cases except 2cases. 4. Most common reason for hanging is marital disharmony. 5. Most common ligature material is the Nylon saree and Nylon duppatta, i.e. easily available soft material at home. 6. Most common type of hanging is complete hanging (63%) and commonest position of knot is to the left side of neck (57%). 7. In the present study the commonest internal neck structure injury is the carotid intimal tear (30%), next common being rupture/contusion to the sternomastoid and other strap muscles of neck (29%). 8. The injury to sternomastoid and other strap muscles of neck are more common in the age group of 40-50yrs. 9. Incidence of carotid intimal tear was more in the age group of 40-50yrs. 10. Injury to hyoid bone and thyroid cartilage were very rare (3%) and it was seen in patients above 40yrs of age. 11. Fracture to cricoid cartilage and cervical vertebra were not seen in any cases (0%). 12. All the neck structure injuries are common in complete hanging.