strangulation forensic medicine important.pptx

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1. Strangulation Dr. Md. Iqbal Bahar Chowdhury Associate Professor , SMAMC

2. Objectives After this class you will be able to know about- Strangulation and its types Postmortem findings of strangulation & throttling Causes of death due to strangulation Difference between hanging from strangulation & postmortem suspension Medicolegal importance & opinion of strangulation

3. Strangulation Strangulation is that form of violent asphyxia which is caused from constriction of the neck by a ligature or any other mechanical means without suspending the body. The constricting force being other than the weight of the body.

4. Types Strangulation proper: -Ligature strangulation. Manual strangulation: -Throttling. Mechanical: - Bansdola -Mugging -Garroting

5. Post mortem findings External: In the face- Cyanosed, swollen Protrusion of eye ball & tongue Tardieu’s spot are seen in the conjunctiva, eyelids. Bleeding from nose may be present.

6. External findings

7. External findings

8. Cont.. In the neck- Ligature mark - transverse, circular or continuous & below the thyroid cartilage The base of the ligature mark is red , abrasion & bruise may be present.

9. Cont.. Tardieu’s spot will be more marked just above the ligature mark There may be scratch marks are seen on the skin near the ligature mark.

10. Cont.. General Findings- Post mortem staining- Deep bluish or reddish purple in color There may be general violence due to struggle. There may be involuntary discharge-urine, stool, semen etc. There may cadaveric spasm with foreign materials found.

11. Cont.. Internal: In the neck- The skin is show marked bruise & hemorrhage . Deep muscles of the neck are grossly bruised. Fracture of the thyroid cartilage is commonly seen.

12. Cont.. Internal organ- - Trachea & larynx are congested. - Lungs are congested & Petechial hemorrhage may present. - Brain & meninges are also congested. - All internal organs are congested.

13. Causes of death Asphyxia Cerebral venous congestion or apoplexy Cerebral anoxia Combined asphyxia & venous congestion Vagal inhibition

14. Medico-legal Importance Homicidal : most common methods all over the world. Accidental : accidental strangulation commonly seen in children, cord around the neck in case of fetus Suicidal ???

15. Accidental strangulation

16. Traits Hanging Strangulation Ligature mark Oblique, non continuous, high up. Transverse, continuous, low down Dribbling of Saliva Present Usually absent. neck Stretched & elongated Not stretched & elongated Hyoid bone Fracture is common Fracture is uncommon. Thyroid cartilage Fracture is less common. Fracture is very common. Carotid arteries Damage may be seen Damage is very rare. Seminal fluid At glans is more common At glans is less common.

17. Traits Hanging PM Suspension Tardieu’s spot Present above the ligature mark Absent Parchmentization Present Absent Saliva Present Absent Semen, blood, urine, feces Present Absent Vital sign in neck tissue present Absent

18. Medico legal Opinion of Strangulation In my opinion, death was due to asphyxia as a result of strangulation which was ante-mortem and homicidal in nature.

19. Mugging(Arm locks) Mugging is a form of strangulation caused by holding the neck of the victim in the bend of the elbow . Character: The attack is usually made from behind. There will be no ligature mark as soft tissue of the elbow act as constriction force. There are external sign of struggle present.

20. Mugging

21. Choke hold Carotid Sleeper

22. Bansdolla It is a form of strangulation in which compression of the neck in between two sticks one is in front of neck another on the back. Character: A linear bruise or injury is seen in front of the center of the neck which does not follow the curvature of the neck Bruise & abrasion also seen at the back of the neck.

23. Garroting It is a form of strangulation in which a ligature is thrown over the neck of the unaware victim from the back & rapidly twisted the ligature with a lever. Character: A transverse circular ligature mark is found. There will be no sign of struggle mark due to sudden unconsciousness. This method is used as death sentence in Spain.

24. Throttling/Manual strangulation It is a form of strangulation in which the palm or fingers of the hand used to compress the front of the neck of the victim. Cause of death; Asphyxia Sudden cardiac arrest by Reflex vagal inhibition

25. Post mortem appearance External: There are scratches & bruise caused by nail & fingertips is found. Crescentic finger nail marks- If one hand is used, thumbnail impression is seen on one side of the neck & other four fingernail marks are seen on the other side of the neck.

26. External findings

27. Cont.. When both hands are used, thumbnail impression of both hands will be in the middle, with rest of the four fingers nail marks are seen on either side of the neck, as one thumbnail mark & finger nails marks of another hand is noticed on each side of the neck.

28. Cont.. Internal: Bruise may be seen over the prominence of the larynx & at the level of cricoid cartilage. There are diffuse extravasations of blood in the soft tissue. Lungs are congested. Brain& Meninges are congested. All internal organs are congested.

29. Is suicidal throttling is possible? No, because the compression of the neck as larynx & trachea produces rapid unconsciousness there by fingers will be relaxed.

30. Medico-legal Importance Homicidal : most common method to commit homicide in case of old, children, intoxicated person. Accidental : may be occur when one playfully holding other’s neck for fun. Suicidal : not possible.

31. Long scarf syndrome

32. Pseudo-strangulation mark

33. Reference The Essentials Of Forensic Medicine And Toxicology by  Dr. K. S. Narayan Reddy Principles of Forensic Medicine: Including Toxicology by  Apurba Nandy Lecture from Sir Salimullah Medical College by Prof. Dr. T.C. Das

34. Thank You