Autopsy Findings in Death Due to Strangulation
A strangulation is a form of violent asphyxial death that is caused by the constriction of the neck utilizing ligature or any other means without suspending the body. It is different from hanging and can be distinguished by observing various features. In strangulation, there is an application of external force due to the compression caused in the neck by hand or a rope, belt, stick, etc.
The cause of death in the case of strangulation might be asphyxia, cerebral hypoxia, cerebral congestion, vagal inhibition, fracture-dislocation of cervical vertebrae, or asphyxia and venous congestion combined. There are different types of strangulation.
Based on means used to constrict the neck, strangulation deaths are classified into- Ligature strangulation, Mugging, Bansdola, Garroting, Palmar strangulation, Manual strangulation/Throttling. Based on the manner of death it is classified into Homicidal and Accidental strangulation.
Ligature Strangulation– It is the violent form of death caused by constricting the neck employing any ligature material like a rope, belt, wire, cable, cloth, etc. without suspending the body.
Throttling– It is a violent asphyxial death when the neck is compressed manually by using human hands.
Mugging– It is also known as arm lock. It is caused by holding the neck of a person in the bend of the elbow thus exerting pressure over the larynx or side of the neck by the forearm and arm.
Garroting– In Spain it was a method of judicial execution where a twisting device is placed around the neck and tightened by a screw causing the victim to strangulate.
Bansdola– A wooden piece, pole, stick or rod, or bamboo is placed over the front of neck and another is placed at the back. Any one end of these sticks will be tied together and the other end is brought close forcefully together to squeeze or compress the neck in between the two sticks, thus causing death.
Autopsy Findings of Strangulation
External Autopsy Findings
- The face will appear puffy, congested, and edematous.
- The eyes will be prominent, open, bulgy, suffused with scleral hemorrhages.
- Conjunctiva shows congestion and petechial hemorrhages. If the strangulation was more violent, then subconjunctival hemorrhage can also be seen.
- Petechial hemorrhage can be seen in the eyelids, face, and forehead.
- Sphincters may be relaxed with the voiding of urine, feces, or semen. Signs of asphyxia will be very prominent.
- The ligature mark over the neck will be very prominent at the sides and front of the neck, well-grooved and defined. If the ligature is twisted multiple times then the marks may be multiple.
- At the area where the knot was made, a wider area of contusion can be seen.
- The marks might appear to be oblique if the victim has been dragged by the cord or if the force was from behind and upward.
- The impression will be identical to the breadth of the ligature used. If the material used was wider, then the impression will also be wide and superficial. But if the material is narrow, it will leave a deeper impression and might appear like a cheese-cutter phenomenon.
- Decomposition does not damage these marks.
- The subcutaneous hemorrhage concerning the mark may be found.
Internal Autopsy FIndings
- The area which was compressed by the ligature mark will show evidence of hemorrhages.
- The neck muscles may show hematoma or even lacerations.
- During the autopsy, the neck structures should be examined at the end after examining the cranial cavity, chest, and abdomen as the neck will be relatively bloodless as the blood will be drained out from the vessels.
- Extravasations or lacerations can be seen on the carotid sheath.
- The base of the tongue may show deep lingual hemorrhages.
- The thyroid region will show subcapsular and interstitial hemorrhage.
- In some cases, the superior horns of the thyroid will be fractured. If excessive force is applied then the cartilage of the larynx or tracheal rings, thyroid lamina, or cricoid cartilage will be fractured.
- Fracture of the hyoid bone is seen mainly in cases of throttling.
- Contusions, scratch marks, abrasions are found mostly in case of manual strangulations.
Strangulation is usually homicidal and rarely accidental. It is necessary to observe the strangulation marks because sometimes to hide the case of homicide, the accused might kill by strangulation and then hang the body to make it look like suicide by hanging.
It is important to distinguish between strangulation and hanging by observing various salient differentiating features. Observing the features of strangulation can also give the idea about the material used, the position of the perpetrator, the force exerted and so on which can help in the further investigation of the case.