Analysis of false-positive hyoid fractures: 12 forensic identification cases / 法医学杂志

OBJECTIVE@#To study the causes of false-positive hyoid fractures and forensic identification.@*METHODS@#Twelve cases of false-positive hyoid fractures were collected and analyzed.@*RESULTS@#Improper dissection technique (4 cases) and congenital separation (8 cases) were the main reasons for false-positive hyoid fractures.@*CONCLUSION@#True fractures can be differentiated from false-positive hyoid fractures. False-positive hyoid fracture caused by improper dissection technique can be identified through examination of peripheral muscle, soft tissue hemorrhage, and the characteristics of fracture end.

X-cephalometric study of different parts of the upper airway space and changes in hyoid position following mandibular fractures / Estudio cefalométrico con rayos X de diferentes partes del espacio de las vías respiratorias superiores y cambios en la posición hioidea tras fracturas mandibulares

OBJECTIVE: This study analyses the different parts of the upper airway space and the changes in hyoid position. The results provide a clinical reference for developing timely and effective treatment programmes for patients with mandibular fractures caused by maxillofacial trauma. METHODS: Standard X-cephalometric measurements of the lateral skull of 210 subjects were taken. The subjects were divided into four fracture groups: condylar, mandibular angle, mandibular body, and parasymphyseal. RESULTS: The radiographs of the mandibular fracture groups were compared with the normal occlusion group to analyse the upper airway space and the changes in hyoid position. Different types of fractures have different effects on the upper airway space. Bilateral mandibular body fracture and the parasymphyseal fracture have a significant influence on the lower oropharyngeal and laryngopharyngeal airway spaces, with serious obstructions severely restricting the ventilatory function ofpatients. CONCLUSIONS: Fractures at different parts of the mandibular structure are closely related to the upper airway and hyoid position.

OBJETIVO: Este estudio analiza las diferentes partes del espacio de las vías respiratorias superiores y los cambios de posición hioidea. Los resultados proporcionan una referencia clínica para desarrollar programas de tratamiento oportuno y eficaz para los pacientes con fracturas de la mandíbula, causadas por trauma maxilofacial. MÉTODOS: Se hicieron mediciones X-cefalométricas estándares del cráneo lateral a 210 sujetos. Los sujetos fueron divididos en cuatro grupos de fractura: ángulo mandibular, condilar, cuerpo mandibular y parasinfisaria. RESULTADOS: Las radiografías de los grupos de fractura mandibular fueron comparadas con el grupo de oclusión normal para analizar el espacio de las vías respiratorias superiores y los cambios de posición hioidea. Diferentes tipos de fracturas tienen diferentes efectos sobre el espacio de las vías respiratorias superiores. La fractura de cuerpo mandibular bilateral y la fractura de parasinfisaria tienen una influencia significativa en los espacios de las vías respiratorias orofaríngea y laringofaríngea inferiores, con serios obstáculos restringiendo severamente la función respiratoria de los pacientes. CONCLUSIONES: Las fracturas en diferentes partes de la estructura mandibular se hallan estrechamente vinculadas a las vías respiratorias superiores y a la posición hioidea.

Newer trends in hanging death.

A total of 105 cases of deaths due to hanging were studied in a span of 5 years time. This present study throws some light on the emerging trends that Hanging is increasingly being adopted by a relatively younger age group who are mostly illiterate and of poor socio-economic status. Hanging being viewed as giving swift painless death and without much expenses and without arousing much suspicion, this mode is increasingly adopted to commit suicide. Dribbling saliva mark, which was a hallmark of Ante-mortem hanging, is increasingly seen in less number of cases. No incidence of fracture of Hyoid bone being seen in this study, due to the fact that most cases were of lower age group and also may be due to most of the victims adopting soft ligatures and low suspension points. Transverse tears in the Carotid arteries were not seen here and on subjecting to Histo-pathological study, we could detect disruption of intimal layer of Carotid artery. Effect of pressure on layers of skin were seen on Histo-pathological study showing vital reaction changes useful for labelling Ante-mortem hanging.

Pattern of neck findings in suicidal hanging A study in Manipur.

Deaths due to hanging are common among suicides. In a study on 84 cases of suicidal hanging brought for autopsy to the mortuary of the Regional Institute of Medical Sciences, Imphal during 2004 to 2008, it was observed that 77.38% of the cases were males and 22.62% were females. The highest number of victims was in the age range of 21-40 years. 73.81% of the cases committed suicide indoors and 57.14% of them used ropes as ligature material. 85.75% of the victims had fixed knots with a single turn and 10.71% had slip knots. Complete atypical hanging constituted 88.10% of the cases. 23.81% of the cases had tear of the carotid artery and 3.57% had hyoid fractures. None of the cases had cricoid or trachea fractures. The neck findings vary depending upon the composition, multiplicity and tightness of the ligature material used, the suspension time, type of hanging, etc. Hence, the possible findings in a suspected case of hanging must be always anticipated so as to avoid any erroneous opinion.

Fracture of hyoid bone in cases of asphyxial deaths resulting from constricting force round the neck.

When any case of hanging, strangulation or throttling comes to the Department of Forensic Medicine for Post-mortem examination, the hyoid bone becomes the most integral part of internal examination at the autopsy table. Many authors and workers in this field have seriously highlighted fracture of hyoid bone. Some have claimed hyoid bone fracture in about 20% cases of hanging. Some have claimed hyoid bone fracture in about 68% cases of hanging. They also claimed that hyoid bone fracture increases with age above 40 years due to calcification and immobilization of joints. Some also claimed that hyoid bone fracture increases with using hard ligature for hanging and strangulation. Fracture of hyoid bone has been ascribed to many factors like manners of constriction, level of application of ligature or force of constriction, long drop or short drop suspension, age of victim, sex of victim etc. Besides getting hyoid bone fracture at autopsy table, it is also very important to check whether it is ante-mortem or post-mortem in nature or just an artifact. For this difficulty some have even advised preautopsy X-ray of the neck structures to detect ante-mortem hyoid bone fracture. Observing the importance given to hyoid bone fracture in hanging, ligature strangulation and throttling cases by many authors at the past and present days, the present authors have taken up the study in 257 cases of hanging, 7 cases of ligature strangulation and 5 cases of throttling to notice that hyoid bone fracture is nil or very rare in hanging where as it is very common in both forms of strangulation.