Neck vascular lesions in hanging cases: A literature review

Conventional and machine learning-based analysis of age, body weight and body height significance in knot position-related thyrohyoid and cervical spine fractures in suicidal hangings

The thyrohyoid complex and cervical spine fracture distribution patterns may reflect the knot position as the force distribution by the noose to different neck regions may vary depending on it. Recently, machine learning models (MLm) were used to classify knot position through these fractures. The contribution of aging on the fracture susceptibility is better demonstrated, but data on body weight (BW) and height (BH) significance on this is more doubtful and MLm did not consider them. A retrospectively obtained autopsy data on sex, age, BW, BH and distribution of greater hyoid bone horn (GHH), superior thyroid cartilage horn (STH), and cervical spine fractures in 368 suicidal hangings were analyzed by standard statistics to determine association of the anthropometrics (age, BW, and BH) with the fracture occurrence, and by machine learning algorithms to determine if body weight and height improved MLm classification of hanging cases with typical and atypical knot positions. In the sample, unilateral GHH fracture was significantly more common in atypical hangings, while isolated STH fractures were more common in typical hangings. Age was a predictor of GHH fractures and BW of STH fractures, but BW poorly correlated with their number. BH was not a predictor of any thyrohyoid fracture. On the ROC curve analysis, the MLm that considered BW and BH did not perform statistically better than MLm that did not consider them. The study indicates that body weight and height are of no detrimental value in assessing the thyrohyoid and cervical spine fracture patterns in suicidal hangings.

Novel aortic lesions in hanging deaths

In response to a recent case report published in the International Journal of Legal Medicine entitled "A case of hemorrhage at the junctions of the posterior intercostal arteries-a vital sign?", we wish to corroborate the findings of periadventitial hemorrhages at the junctions of the posterior intercostal arteries in cases of suicidal hanging and to reveal two other novel aortic lesions associated with hanging. In our ongoing prospective study, we identified six cases of aortic intimal ruptures among 257 suicidal hanging deaths, along with the novel observation of subintimal hemorrhages-both of which have not been previously documented in the forensic literature. Our findings suggest that the complex anatomy of the aorta and surrounding structures may increase the vulnerability of vascular structures during hanging, particularly under conditions of complete suspension. We propose that reported aortic lesions may serve as significant morphological indicators of hanging, thereby enriching its medicolegal investigation. To establish the diagnostic relevance of these findings, further prospective autopsy studies with larger sample sizes are warranted.

Unusual autopsy, unusual tissue(s) for DNA, but a useful genetic profile: A case of the DNA profiling from the human tissue of challenged provenance

The autopsy of the non-fresh cadaver is characterized by inherent difficulties in that it requires the adoption of genetic and histological investigation techniques to the specific case. The case that the authors present in this paper concerns the corpse of a young woman who had already been autopsied, then treated with 20 % neutral buffered formaldehyde, a preserving agent, to enable its intercontinental transport, and then autopsied again. At the judge's request, a second judicial autopsy was performed in order to verify the cause of death and to carry out genetic investigations. As fresh tissue was not available to perform the genetic analysis, three different tissue matrices were taken: retina, liver, and iliopsoas muscle. The biological matrices taken were chosen as they were considered less likely to be in contact with formaldehyde and therefore probably less prone to artifacts caused by the action of formalin on the DNA structure. All three biological matrices were used to obtain a genetic profile. In particular, the genetic data obtained from the retina was found to be better than the genetic profile obtained from the iliopsoas muscle. In turn, the genetic profile obtained from the iliopsoas muscle was found to be better than the genetic data obtained from the liver sample.

Epidemiological, Gross Morphological, And Histopathological Analysis Of Postmortem Cases Of Hanging - An Observational Study

Background

Death due to hanging is commonly seen. Sometime the ligature mark will be very prominent and in some cases it might not. In those cases, the post-mortem examination with its gross morphological findings and histopathological analysis, becomes significantly important. Objective: The objective of this study was to identify the patterns of epidemiological, gross morphological, and histopathological features in hanging cases.

Methods

The study was conducted on 46 cases of hanging and was carried out from February 2023 to June 2024. Their sociodemographic features were collected. Gross morphological analysis of the ligature mark and various measurements were taken. Later tissue from the ligature mark was sent for histopathological analysis. Statistical analysis was performed on the collected parameters.

Results

Significant male preponderance was observed in hanging cases. The maximum number of cases of hanging were observed in the fourth decade of life. Daily wage workers were the most significantly affected population. Depression was cited as the cause of suicide in most cases. Carotid intimal tears and injuries to bony and cartilaginous structures were present in smaller numbers. Vital reaction was observed in all 46 cases. Classification of wound vitality showed a correlation to known time since injury.

Conclusion

The results of the present study showed that socio-demographic factors play a significant role in the circumstances leading to suicidal deaths. Therefore, in reducing the burden of suicidal deaths, these factors must be addressed. To identify the cause of death as hanging analysis of various gross features and histopathology are very important and should be conducted carefully.

Assessing the knot in a noose position by thyrohyoid and cervical spine fracture patterns in suicidal hangings using machine learning algorithms: A new insight into old dilemmas

Hanging is one of the most common suicide methods worldwide. Neck injuries that occur upon such neck compression - fractures of the thyrohyoid complex and cervical spine, occupy forensic pathologists for a long time. However, research failed to identify particular patterns of these injuries corresponding to the force distribution a ligature applies to the neck: the issue of reconstructing the knot in a noose position persists. So far, machine learning (ML) models were not utilized to classify knot positions and reconstruct this event. We conducted a single-institutional, retrospective study on 1235 autopsy cases of suicidal hanging, developed several ML models, and assessed their classification performance in a stepwise manner to discriminate between: 1. typical ('posterior) and atypical ('anterior' and 'lateral') hangings, 2. anterior and lateral hangings, and 3. left and right lateral hangings. The variable coding was based on the presence/absence of fractures of greater hyoid bone horns (GHH), superior thyroid cartilage horns (STH), and cervical spine. Subject age was considered. The models' parameters were optimized by the Genetic Algorithm. The accuracy of ML models in the first step was very modest (c. 60%) but increased subsequently: Multilayer Perceptron - Artificial Neural Network and k-Nearest Neighbors performed excellently discriminating between left and right lateral hangings (accuracy 91.8% and 90.6%, respectively). The latter is of great importance for clarifying probable hanging fracture biomechanics. Alongside the conventional inferential statistical analysis we performed, our results further indicate the association of the knot position with ipsilateral GHH and contralateral STH fractures in lateral hangings. Moreover, odds for unilateral GHH fracture, simultaneous GHH and STH fractures, and cervical spine fracture were significantly higher in atypical ('anterior' and 'lateral') hangings, compared to typical ('posterior') hangings.

A suicide case by hanging without fixing the end of the rope

Hanging is a method of death in which one end of a cord is tied around the neck and the other end is tied to an unmovable object and hung down, compressing the neck with weight. We have identified a rare case in which death was accomplished without tying one end of the rope. The individual was successfully hanged by the frictional force between the upward rope and the downward rope. The police concluded the case as a suicide.