Neck Injury by Strangulation/hanging

Basics

Strangulation:
- Ligature: Material used to compress structures of neck
- Manual: Physical force used to compress structures of neck
- Postural: Airway obstruction from body weight (over an object) or position (typically in infants)
Hanging is a form of strangulation:
- Complete (judicial type): Victim's entire body is suspended off the ground
- Incomplete (nonjudicial): Some part of victim's body contacts the ground
- Typical: The point of suspension is placed centrally over the occiput
- Atypical: The point of suspension is in any position other than over the central occiput
- Intentional: Suicide, homicide, autoerotic, “choking game”
- Accidental: Often children or clothing caught in machinery
- Near-hanging: Survival following nonjudicial hanging

Hanging (judicial):
- Victim is dropped a distance at least equal to his or her height
- Forceful distraction of head from torso results in a decapitation type of injury (fracture of cervical spine and transection of spinal cord)
Hanging (nonjudicial):
- Typically occurs from a lower height
- Injuries mimic nonjudicial strangulation
Strangulation:
- Asphyxia by closure of the blood vessels and/or air passages of the neck as a result of external pressure on the neck
- Three causes: Hanging, ligature strangulation, and manual strangulation
- Cervical spine injuries are uncommon except with judicial-type hanging
Death:
- Secondary to mechanical closure of blood vessels or airway
- Secondary to cardiac arrest from extreme bradycardia due to increased vagal tone from carotid sinus pressure
- Secondary to direct neurologic injury to the spinal cord
- Secondary to pulmonary complications in near-hanging victims
- Secondary to cerebral hypoxia

Cervical spine injury
Hypoxic cerebral injury
Arterial or venous dissection/thrombosis
Hyoid bone fracture:
- Typically seen in nonjudicial strangulation
Cricoid cartilage disruption (rare)
Thyroid cartilage disruption:
- More common in nonjudicial strangulation deaths
Phrenic nerve injury
Airway edema
Acute respiratory distress syndrome (ARDS)
Aspiration pneumonitis (may be late)
Neurogenic pulmonary edema (may be late):
- Due to massive central sympathetic discharge
Postobstructive pulmonary edema (may be rapid onset):
- Due to negative intrapleural pressure resulting from inspiration against an external airway obstruction
Air embolism:
- Consider when subcutaneous (SC) air and vascular injuries are present

There's more to see -- the rest of this topic is available only to subscribers.