J Indian Acad Forensic Med. Jan-March 2013, Vol. 35, No.

1

ISSN 0971-0973

Original Research Paper
A Study of Gross Postmortem Findings in Cases of
Hanging and Ligature Strangulation
*Mohammed Musaib M. Shaikh, **H. J. Chotaliya, **A.D. Modi, ***A. P. Parmar, ****S. D. Kalele

Abstract
This present study was performed on cases of death due to compression of neck by ligature
material due to hanging and strangulation brought for post-mortem examination at mortuary of Sir
Takhtasinhji General Hospital and Govt. Medical College, Bhavnagar, Gujarat, India during January 2011
to December 2011. A total of 1044 post-mortem examinations were conducted, out of which 90 cases
were of compressed neck by ligature. Out of them 86 cases were of hanging and 4 cases were of ligature
strangulation. We observed that dribbling of saliva was present in some cases of hanging but not present
in any case of ligature strangulation. Similarly fracture of hyoid bone and thyroid cartilage were present in
cases of hanging while not present in any case of ligature strangulation. Larynx, trachea and cervical
vertebra were not fractured in any case of hanging and ligature strangulation. All cases of hanging were
suicidal while three cases of ligature strangulation were homicidal and one case was accidental.

Key Words: Hanging, Ligature strangulation, Hyoid Bone, Thyroid Cartilage, Compression of neck
Hence authors have made a prompt and
sincere attempt to study external and internal
features in the neck in cases of hanging and
ligature strangulation.

Introduction:
Violent asphyxial deaths is one of the
most important cause for unnatural deaths
among which hanging and ligature strangulation
are commonly encountered in the professional
life of forensic expert during day to day autopsy.
Deaths resulting from hanging and
ligature strangulation show features amongst
which the ligature mark at the neck is
considered
to
be
decisive.
However
characteristic finding, the ligature mark, found
around
the neck
in both hanging
and
strangulation creates doubt in many cases.
It is easy to diagnose hanging and
ligature strangulation when one finds the
classical features. However all features are
seldom present together. The application of
pressure on the neck often results in findings,
which are quite variable. A proper assessment
of various post-mortem findings is therefore
necessary under such circumstances. Apart
from the typical ligature mark, atypical ligature
marks are also seen leading to lot of curiosity in
the mind of autopsy surgeon during the day-today postmortem examination.

Materials and Method:
A prospective study was conducted on
90 cases of compressed neck by ligature due to
hanging and strangulation out of 1044 cases
brought for autopsy to the mortuary of Sir
Takhtasinhji General Hospital and Govt. Medical
College, Bhavnagar, during period of January
2011 to December 2011. Detailed information
with the crime scene investigation findings and
photographs were collected and thoroughly
studied before conducting post mortem
examination.
Irrespective
of
information
collected, both external and internal post
mortem findings were observed very carefully
with standard autopsy protocol. The findings are
recorded and analysis was done between
various findings of hanging and ligature
strangulation.

Observation:
In the present study, we found that
ligature mark was obliquely placed in all cases
of hanging and above the level of thyroid
cartilage in 72.09% cases and at the level of
thyroid cartilage in 27.91% cases, while in all
cases of ligature strangulation the mark was
transverse and below thyroid cartilage. Out of 90
cases of neck compression, in internal
appearance of underlying soft tissues of neck
were pale, white and glistening in all cases of

Corresponding Author:
rd

*Tutor & 3 year Resident,
Department of Forensic Medicine,
Government Medical College, Bhavnagar, Gujarat
E-mail: dr.msbshaikh@gmail.com
rd
**3 year Resident
***Assoc. Prof, ****Prof & Head
DOR:23.10.12 DOA:25.2.13

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J Indian Acad Forensic Med. Jan-March 2013, Vol. 35, No. 1
hanging while in all cases of ligature
strangulation it showed extravasation of blood.
Dribbling of saliva was present in
38.37% cases of hanging but not present in any
cases of ligature strangulation. Bleeding from
mouth and nose found in all cases of ligature
strangulation but only in 1 case (1.16%) of
hanging. Facial congestion and cyanosis
present in 34.88% cases of hanging while in all
cases of ligature strangulation.
In 86 cases of hanging, hyoid bone was
fractured in 10 cases (11.63%). Out of 10 cases,
7 cases (8.14%) were male and 3 cases (3.49%)
were female. While in 2 cases (2.33%) of
hanging thyroid cartilage was fractured, which
both were male. Hyoid bone and thyroid
cartilage, cricoid cartilage were not fractured in
any case of ligature strangulation. Larynx,
trachea and cervical vertebra were not fractured
in any case of hanging and ligature
strangulation.
In the present study 70 cases (81.39%)
of hanging did not show any periligature injuries
around the ligature marks, while in all cases of
ligature strangulation periligature injuries were
present around ligature mark.
Only in one case of hanging, incised
wound was present on antero-lateral aspect of
left wrist joint, with multiple small hesitationcuts, present just below the wound. In all cases
i.e. 4 cases of ligature strangulation, there were
external injuries (i.e. contusion, laceration,
abrasion) out of them intracranial injury was also
observed in one case.

ISSN 0971-0973

present in all 4 cases of ligature strangulation,
which is also consistent with observations of
Sarangi M.P. [2] Involuntary discharge of urine
was present in 12 cases, fecal discharge
present in 11 cases and semen on glans penis
present in 10 cases of hanging while involuntary
discharge of fecal matter was present in only
one case of ligature strangulation.
Table 5: Incidence of Fracture of Hyoid Bone
in Cases of Hanging Compared With Other
Workers
S.N.

Authors
1
2
3
4
5
6

Sarangi et al2
Chormunge Patil et al4
Tripude B H et al5
Sheikh M I.et al6
Meera et al7
Present study

Fracture of hyoid bone
9.4% cases
7.14% cases
64.51% cases
5.08% cases
3.57% cases
11.63% cases

Out of 90 cases of neck compression in
5 cases (5.55%) associated injuries to other
body parts were present. In which 1 case
(1.16%) was of hanging along with multiple
incised wound at left wrist i.e. hesitation cut
marks and rest 4 (100%) were of ligature
strangulation along with contusion, abrasions
and head injuries. Presence of other bodily
injuries due to resistance and/or violence
besides the ligature mark around the neck
suggests only homicidal death but not about the
manner of constriction.
In case of hanging, incidence of fracture
of hyoid bone (11.63%) in present study is
almost similar with study of Sarangi et al [2] and
Chormunge Patil et al [4] but lower than study of
Tripude B H. et al. [5] In ligature strangulation
incidence of fracture of hyoid bone was 14.28%
6
observed by Sheikh M I. et al and 12.5% by
Chormunge Patil et al. [4] These are different
from present study in which hyoid bone was not
fractured in any case of ligature strangulation.
In present study, incidence of injury to
thyroid cartilage was observed in 2.33% cases,
which is similar to study of Meera et al [7], who
observed injury to thyroid cartilage was in 2.38%
cases. Fracture of cricoid cartilage, tracheal
rings and cervical vertebrae were not observed
in any cases of neck compression which was
similar to observation of Meera et al [7] and
Chormunge Patil et al. [4]
Periligature injuries in the form of
abrasion bruise and rope burns were present in
16.28% cases of hanging and in 1 case (25%) of
ligature strangulation. The rope burns (friction
burns) are due to friction of the ligature material
against the skin due to slippage of the material.
The above features were observed in the
studies conducted by Pradeep Kumar et al. [8]
Nail scratch marks inflicted by the struggling

Discussion:
In the present study of total 90 cases of
neck compression by ligature, 86 cases
(95.56%) were of hanging and 4 cases (4.44%)
were of ligature strangulation.
Dribbling of saliva was found in 33
cases (38.37%) of hanging and not found in any
cases of ligature strangulation. The findings are
consistent with those of Ashok Kumar Samanta
et al [1] who observed 32.31% cases with
dribbling of saliva. Sarangi M.P. [2] found
dribbling of saliva in only 14 cases (11%) of
hanging and did not find in any cases of ligature
strangulation. Dribbling of saliva is sure sign of
hanging having taken place during life. Paliwal P
K. et al [3] with the help of investigative and
reconstructive Forensic Medicine to decodify the
mystery of death by saliva found in the form of
drop over the lower lip as observed in the
photographs taken from the scene of crime, they
opined it was ante-mortem hanging.
Bleeding from mouth and nose was
seen only in one case of hanging while it was

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J Indian Acad Forensic Med. Jan-March 2013, Vol. 35, No. 1
2.

victim to free himself present in 2 cases (2.33%)
of hanging and all cases of ligature
strangulation. In 86 cases of hanging, on the
basis of circumstances of death and postmortem
findings the manner of death was suicidal.
While in four cases of ligature
strangulation in three cases, the manner of
death was homicidal and in one case it was
accidental. Accidental strangulation is not very
common, but it may occur when an article of
clothing, a neck band, a cord, or a chain is
tightly drawn round the neck all of a sudden,
occasionally seen in male worker, who are
caught by moving belt of machine. In present
study, a case of accidental ligature strangulation
in 28 years female was observed who had her
sari caught on the machine where she was
working. Similar case of accidental ligature
strangulation was observed by Zine K U. et al.
[9]

3.

4.
5.

6.
7.
8.
9.

Conclusion:
Dribbling of saliva present in case of
hanging while rarely [10] in case of ligature
strangulation. Post mortem findings like bleeding
from mouth and nose, cyanosis, involuntary
discharge of urine, fecal matter, semen on glans
penis, periligature injuries, fracture of hyoid
bone, thyroid cartilage, larynx and trachea in
cases of hanging and strangulation are nonspecific
and
variable
depending
upon
composition of ligature material, force applied on
neck and its duration. However either singly or in
combination these findings helpful when ligature
mark creates element of doubt in cases of
hanging and ligature strangulation.
It can be concluded that presence of
other bodily injuries suggest only manner of
death
not
about
hanging
or
ligature
strangulation. In doubtful cases final opinion will
be made depending upon circumstantial
evidence, crime scene investigation and autopsy
findings.

10.

Sarangi M. P. “Ligature mark/s” – In Forensic pathologist’s
perspective. Journal of Forensic Medicine and Toxicology. Jan –
June 1998, Vol. XV No. 1 pp 99 – 102
Paliwal P. K, Basant Lal Sirohiwal, Vijay Pal Khanagwal, Hitesh
Chawla. A drop of saliva de-codes the mystery of hanging body.
Journal of Indian Academy of Forensic Medicine. July-Sep 2011,
Vol. 33, No. 3.pp280-282.
Chormunge Patil, Mahajan S. V, Bhusari P. A. Hanging vs.
strangulation a comparative study. Journal of Forensic Medicine,
Science and Law. Jul-Dec 2011. Vol. 20, No.2 pp 1-5
Tripude B H, Murkey P N, Pawar V G, Shende S A. Profile of
Hanging Cases on Autopsy at a Tertiary Care Hospital In Central
India. Journal of Karnataka Medico-legal Society Jan-Jun 2010, Vol.
19, No.2 Pp 3-7.
Sheikh M. I. and Agarwal S. S. Medico-legal implications of hyoid
bone fracture- a study paper. Journal of Indian Academy of
Forensic Medicine. 2001 Vol. 23. Number 4. pp 61 - 63.
Th. Meera, Bipin Kumar Singh M. Pattern of neck findings in
suicidal hanging. Journal of Indian Academy of Forensic medicine.
Oct-Dec 2011, Vol 33,( 4) pp350-352.
Pradeep Kumar G., Manoj Kumar Mohanty, Shanavaz Baipady.
“Rope Burns: A feature of Antemortem Hanging”. Journal of
Karnataka Medico-legal Society, 2002; 11 (2): 25-26.
Zine K. U., Tandle R. M., Varma N. M., Jambure M. P. Accidental
Ligature Strangulation with Avulsion of Scalp. Journal Indian
Academy Forensic Medicine. July-Sept 2011, Vol. 33, No.3, pp 267
– 268.
Punia R. K, Gupta B. M. A rare case of ligature strangulation with
salivary staining. Journal Indian Academy Forensic Medicine. Vol.
31, No.3; pp 262-263.

Table 1: Distribution of External Postmortem
Findings
External PM findings

Hanging

Dribbling of saliva
Bleeding from mouth and nose
Facial congestion and cyanosis
Discharge of Urine
Faecal discharge
Semen on glans penis
Injuries to other body parts

33 (38.37%)
1 (1.16%)
30 (34.88%)
12 (13.95%)
11 (12.79%)
10 (11.62%)
1 (1.16%)

Ligature
strangulation
0
4 (100%)
4 (100%)
0
1 (25%)
0
4 (100%)

Table 2: Distribution of Periligature Injuries
Periligature Injuries

Hanging

Ligature
strangulation
14 (16.28%) 1 (25%)

Abrasion, Bruise, Rope Burns
Nail Scratch Marks

2 (2.33%) 4 (100%)

Table 4: Manner of Death (On the Basis of
Circumstances of Death and Postmortem
Findings)

References:
1.

ISSN 0971-0973

Ashok Kumar Samanta, Soumya Rajan Nayak. Newer trends in
hanging death. Journal of Indian Academy of Forensic Medicine.
2012, Vol. 34 (1) pp 37 – 39.

Type
of
Neck
Compression
Hanging
Ligature strangulation

Manner of Death
Suicidal
Accidental
86
0
0(100%)
1 (25%)

Homicidal
0
3 (75%)

Table 3
Distribution of Injuries to Bones and Cartilages of Neck
Type of Neck Compression
Hanging
Ligature strangulation

Hyoid Bone Fracture
10 (11.63%)
0

Thyroid cartilage Fracture
2 (2.33%)
0

65

Larynx and Trachea Fracture
0
0