Trauma to the hyoid bone and laryngeal cartilages in hanging: Review of forensic research series since 1856

• Reported percentage of injured neck complexes in fatal hanging ranges from 0 to 83%.
• The reason for discrepancy is difference in research approach and methods used.
• Only complete preparation, as a method of “gold standard”, can find every lesion.
• Real index of trauma to the laryngopharynx complex in hanging is about 70% of cases.

Since 1856 lots of forensic reports, concerning trauma to the hyoid bone and laryngeal cartilages in hanging, have been published. Differences in percentage of injured neck complexes ranged from 0 to 83.3%. Simple arguments suggest that the reason for discrepancy is difference in scientific approach (retro- or prospective) and use of various research methods. Comparative analysis of widely used techniques shows considerable variety in their effectiveness. Plain radiography and palpatory method have fairly low sensitivity (33–60% for different elements of the neck complex) with relatively high specificity (89–98.5%). Reported sensitivity of postmortem CT in identification of different lesions (including fractures) in trauma victims for the head/neck region is higher than 53% in different series with possible false-positive findings. In clinical setting the whole-body CT (pan-scanning) in blunt trauma patients showed sensitivity for head and neck injuries at the level of 84.6%, and specificity – 98.9% (Stengel et al., 2012 [68]). Only complete preparation allows to identify all the damages to the laryngopharynx framework, to avoid false diagnostics and ascertain the exact location, morphology, mechanism and intravital nature of the neck trauma. Currently complete preparation can be regarded as the method of “gold standard”. Use of this method shows the frequency of discovered injuries in hanging to be about 70% of cases. In practical use, one should consider radiological techniques and palpation as preliminary and orienting methods (rather excluding, than revealing anterior neck trauma).