A number of pathologic findings may be found in a victim of strangulation. Some of these findings are subtle, and problems may arise if the postmortem examination is not performed properly.
Recommendations for pathologic examination:
(1) Dissection of the neck should be performed after thoracic evisceration and removal of the brain. The shoulders should be elevated on a head block to allow drainage of blood from the blood vessels.
(2) The technique of cutting the posterior of the aspect of the cricoid cartilage and larynx and then manually opening the larynx like a book should be avoided, since this causes fractures which may obscure antemortem fractures or be misinterpreted as false positive evidence of strangulation.
(3) Maxeiner gives instructions on how to perform the examination properly (pages 785-786). This may best be performed after formalin fixation of the specimen removed en bloc.
(3a) Incision into the cricothyroid joints, by incising between the cricoid and thyroid cartilages,
(3b) Incision into the posterior cricoarytenoid muscles to expose the cricoarytenoid joints.
(3c) The soft tissue of the paraglottic space can be removed from the dorsal surface of the thyroid laminae.
(3d) Horizontal section through the cricoid cartilage from anterior to posterior.
(3e) Vertical midline incision through the posterior of the larynx to open the wall. The mucosa and vocal cord is then incised to detect hemorrhages.
Pathologic findings in strangulation may include:
(1) fracture of the hyoid bone, which may be complete, incomplete, or non-dislocated
(2) fractures of the thyroid cartilage, which may be complete, incomplete, or non-dislocated
(3) fractures of the cricoid cartilage, which may be complete, incomplete, or non-dislocated
(4) hemorrhage into laryngeal muscles, especially the vocal folds
(5) hemorrhage into the laryngeal joints
(6) hemorrhage into the laryngeal mucosa
(7) bruising (interstitial hemorrhages) into the subcutaneous fat
(8) bruising of the strap muscles
(9) hemorrhage into the thyroid gland
(10) pinpoint hemorrhages in the facial skin, especially the conjunctivae and eyelids (Tardieu spots)
Manual strangulation may or may not show external markings:
(1) Hemorrhages into the laryngeal soft tissue is relatively common.
(2) Markings of the perpetuator's fingers or instrument may be seen in the skin of the neck. A fingernail mark appears as a linear or curved abrasion of the skin.
(3) Abrasions on the chin of the victim are common.
Ligature strangulation:
(1) Markings on the neck are horizontal.
(2) Markings on the neck are usually below the level of the thyroid cartilage.
(3) Fractures of the hyoid bone and/or thyroid cartilage are common, while fracture of the cricoid cartilage is less common.
(4) Hemorrhages into laryngeal soft tissue are less common than in manual strangulation.
(5) The patient may scratch the skin of the neck to attempt to loosen the ligature.
(6) The ligature may still be in place about the neck.
Hanging:
(1) Markings in the neck depend on the angle of the instrument. If the person was hung from above, then the markings pass upward towards the knot. If the person is lying done then the markings may be horizontal.
(2) Markings on the neck are usually above the thyroid cartilage.
(3) The hyoid bone and thyroid cartilage may be intact.
(4) The noose may still be in place about the neck.
If the body has been under water, then external dermal markings may not become evident until after the body has dried for several hours.
Some of the findings are suggestive but not pathognomonic, with similar pathologic changes seen in:
(1) automobile accidents
(2) falls onto objects
(3) resuscitation attempts and intubations
Specialty: Clinical Laboratory, Emergency Medicine, Pulmonology
