Pattern of internal neck injuries in suicidal hanging: A histopathological and gross examination - Based study

Hanging is a common method of suicidal asphyxiation, often leaving distinct external and internal neck injuries. This study aims to analyse the pattern of internal neck injuries in suicidal hanging cases through both gross and microscopic examination.

A total of 34 cases of suicidal hanging, autopsied over one year, were analysed for gross and histopathological findings in the internal neck structures. Histopathological examination of the sternocleidomastoid muscle and thyroid gland was conducted to assess internal injuries.

Most cases (n=24; 70.6%) were males, with the highest incidence in the 21-30-year age group (44.1%). Atypical hanging was more common (n=26; 76.5%), with the knot positioned laterally in most cases. The predominant ligature materials were soft and broad fabrics (n=20; 58.8%). Gross internal examination showed visible soft tissue injuries in only 17.6% of cases, while histopathological analysis revealed microscopic damage in 91.2% of cases (p<0.05). The most frequent histopathological findings included congestion (67.6%) and follicular destruction (32.4%) in the thyroid gland, and hemorrhages (47.1%) and muscle fibre degeneration (55.9%) in the sternocleidomastoid muscle. Hyoid bone fracture was rare (2.9%), and no fractures of the thyroid cartilage or cervical vertebrae were observed. Intimal tears in the carotid arteries were detected in 5.9% of cases.

The study highlights the significance of histopathological examination in detecting internal neck injuries in suicidal hanging. While external findings provide crucial preliminary evidence, microscopic analysis reveals subtle antemortem tissue changes that may be undetectable on gross examination.