Coexistence of Subdural Hematoma and a Rare Cardiopathy in an Infant: Etiological and French Medicolegal Discussion.

During legal proceedings following the unexpected death of an infant, the magistrate calls on an expert to clarify the causes of death and to decide on the course to be taken. A report was made following the death of a 7-month-old baby girl after recovery from cardiac arrest when investigations of the cause revealed a subdural hematoma (SDH). We discuss the interconnection of these two entities and their role in the lethal process. In this infant, two distinct lesions with medicolegal implications were simultaneously present: on the one hand histiocytoid cardiopathy, and on the other hand SDH, which could result from ill-treatment. The case of this infant reminds us that the role of the pediatrician is to report the suspicion, whereas the role of the medical expert is to inform the magistrate as to the reality of abuse and its implication in the lethal process.

Manual strangulation: experimental approach to the genesis of hyoid bone fractures.

Discovery of a fracture of the hyoid bone during forensic autopsy is a feature that raises suspicions of constriction of the neck. Studies have shown the influence of gender and build of the individual on the morphology of this bone. Our aims were to confirm these findings and to develop an experimental protocol for simulating manual strangulation in order to determine the force required to fracture the hyoid bone and the influence of anthropometric parameters on this force. A total of 77 intact hyoid bones were obtained, scanned, modeled, measured and embedded in resin. Using a hydraulic press, we applied force to the distal extremity of the greater horn. The relationships between the parameters of sex, weight and height of the subject, anteroposterior length of the hyoid, width between the greater horns, angle, fusion of the greater horns and force applied were analyzed. Our study confirmed sexual dimorphism, shown by greater length in males (>37.8 mm) than in females, and a larger angle in females (a shorter bone with a width>43.7 mm and an angle>31°01). The study confirmed the positive correlation between the length of the hyoid and the weight and height of the subject (p<0.05). Sixty-seven of the 77 hyoid bones fractured during the experiment (87% fracture rate). Of the fractures, 48% occurred at the junction between the body and the greater horns, 49% in the greater horns (mean distance from the distal extremity of the horn 17.33±4.37 mm), and 3% in the median part of the body. No significant association was found between gender and type of fracture, or between fusion or non-fusion of the horn (p>0.05). Fused bones were not more susceptible to fracture than non-fused bones. Fracture occurred at a mean force of 30.55 N (±18.189). Multiple linear regression showed a significant negative correlation between force required for fracture and age, weight and height of the subject, anteroposterior length and angle. The younger the individual, the slighter their build, the longer the bone and the smaller the angle, the greater the force required to fracture the hyoid bone.

Analysis of hyoid bone using 3D geometric morphometrics: an anatomical study and discussion of potential clinical implications.

The aim of this study was to obtain a quantitative anatomical description of the hyoid bone using modern 3D reconstruction tools and to discuss potential applications of the knowledge in clinical practice. The study was conducted on 88 intact hyoid bones taken from cadavers during forensic autopsies (group 1) and on 92 bones from CT scan images of living adult subjects (group 2). Three-dimensional reconstructions were created from CT scan images using Amira 5.3.3® software. An anatomical and anthropological study of hyoid bones was carried out using metric and morphological analyses. Groups 1 and 2 were compared to evaluate the influence of muscle traction on hyoid bone shape. Characteristics of the hyoid bone were highly heterogeneous and were closely linked with the sex, height, and weight of the individuals. Length and width were significantly greater in men than in women (39.08 vs. 32.50 mm, p = 0.033 and 42.29 vs. 38.61 mm, p = 0.003), whereas the angle between the greater horns was larger in females (44.09 vs. 38.78, p = 0.007). There was a significant positive correlation between the height (Pearson coefficient correlation r = 0.533, p = 0.01) and weight (r = 0.497, p = 0.01) of subjects and the length of the hyoid bone. Significant metric differences were shown between group 1 and group 2. This very reproducible methodology is important because it may lead to clinical studies in, e.g., head and neck cancer or sleep apnea. Such studies are ongoing in our research program.