Rare Inward Compression Fracture of Hyoid Bone In Hanging: A Case Report and Review of Literature

Abstract

Fracture of hyoid and laryngohyoid complex may result from violence like strangulation, hanging, accidents, therapeutic interventions or  postmortem processing. Inward compression fracture of hyoid bone usually indicates strangulation, and unexpected finding of hyoid  fracture may cast suspicion of throttling or manual strangulation and may misguide the investigation. Here, we report a case of a rare,  occurring inward compression fracture of hyoid bone identified in the autopsy examination of a 41-year-old decedent male who  committed suicide by complete hanging. A41-year-old man decedent committed suicide by complete hanging with a thin, cord-like nylon rope. At autopsy, the authors observed a  typical incomplete, obliquely placed grooved ligature mark on the neck. After achieving a bloodless field in the neck, layer by layer  dissection was done. Internal examination revealed inward displaced greater cornu of the hyoid bone suggesting periosteal tear of the outer  side at the junction of the body with right greater cornu. The displaced fragment was mobile in one direction, offering one degree of  movement freedom. This finding of inward compression fracture of the hyoid is rare in hanging. Focal bleeding at the site confirmed the  fracture and proved its intravital nature.Fracture of hyoid following strangulation or hanging is well documented in the literature. In a suspected case of compression of the neck,  fracture of the hyoid bone indicates throttling. However, the presence of unexpected fracture of the hyoid bone in a case of hanging may  create confusion, raising the possibilities of direct trauma to the neck and possibly third-party involvement. It is, therefore, essential that  the forensic pathologist adopt proper dissection techniques in interpreting injuries to the osseocartilaginous structures of the laryngohyoid  complex.