Spectrum of Internal Neck Injuries in Hanging: A Decadal Autopsy-Based Study (2011-2020)

Background: Hanging is one of the most commonly employed methods for suicide globally, particularly in Asian countries. Hanging forms a major proportion of all medico-legal autopsies. Although external post-mortem findings are well illustrated in the literature, internal neck manifestations and their association with demographic and mechanical variables remain inadequately explored. This study aimed to evaluate internal neck injuries in hanging and analyse their correlation with the type of suspension, age, gender, and ligature material. Material and Methods: A retrospective analytical study was conducted on 169 established cases of hanging over ten years (2011 to 2020). Internal findings included sternocleidomastoid haemorrhage, carotid artery intimal tears, hyoid bone fractures, thyroid cartilage fractures, cervical vertebral fractures, spinal cord contusions, and thyroid gland haemorrhages. Statistical analysis was performed using the Chi-square test and Fisher’s exact test where appropriate. Results: Sternocleidomastoid haemorrhage was the most frequent finding (78.70%), followed by hyoid fracture (17.16%) and carotid intimal tear (15.38%). Significant associations were observed between complete hanging and sternocleidomastoid haemorrhage (p < 0.001) as well as carotid injury (p = 0.04). Hyoid fractures showed a significant association with increasing age (p = 0.004). No association was observed with gender or ligature material. Conclusion: These findings highlight the influence of mechanical and anatomical factors in determining internal injury patterns and reinforce the importance of analytical evaluation in medico-legal interpretation.

Keywords: Hanging, Hyoid bone fracture, Carotid artery injury, Internal neck injuries.