SpringerLink
Log in

Incidence and factor analysis of laryngohyoid fractures in hanging individuals—computed tomography study

  • Forensic Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Although laryngohyoid fracture indicates the applied neck pressure and is an important finding in hanging individuals, the reported rate varies widely and its true incidence remains controversial. We used computed tomography (CT) studies to investigate the incidence of laryngohyoid fracture in hanging individuals and identify factors contributing to such fractures.

Methods

Considered for inclusion in this study were 107 attempted or successful hanging individuals subjected to CT studies between 2005 and 2019. After excluding 19 whose images were inadequate for evaluation, 88 subjects were included. Body suspension was complete in 20, partial in 49, and unknown in 19; 54 (61.4%) individuals died. Two radiologists performed image analysis and recorded the presence and site of laryngohyoid fractures. Multiple logistic regression analysis was used for factor analysis of laryngohyoid fractures; it included the gender, the age (< or ≧ 40 years), the type of suspension (complete or incomplete), and the outcome (death or survival).

Results

Of the 88 subjects, 35 (39.8%) presented with laryngohyoid fractures on CT images; the superior horn of the thyroid cartilage was fractured in 32 (91.4%) of the 35. Age was the only factor significantly related to laryngohyoid fracture (odds ratio = 2.85, 95% confidence interval = 1.08–7.52).

Conclusions

In hanging individuals, the incidence of laryngohyoid fracture on CT images was 39.8%. The superior horn of the thyroid cartilage was the most frequent fracture site.

Key Points

• The incidence of laryngohyoid fracture on CT images of hanging individuals was almost 40%; the superior horn of the thyroid cartilage was the most frequent fracture site.

• In older hanging individuals, attention must be paid to laryngohyoid fractures on CT images.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

95% CI:

95% confidence interval

AEC:

Automatic exposure control

FOV:

Field-of-view

OR:

Odds ratio

PMCT:

Postmortem computed tomography

References

  1. Deininger-Czermak E, Heimer J, Tappero C, Thali MJ, Gascho D (2020) The added value of postmortem magnetic resonance imaging in cases of hanging compared to postmortem computed tomography and autopsy. Forensic Sci Med Pathol 16:234–242

    Article  Google Scholar 

  2. Gunnell D, Bennewith O, Hawton K, Simkin S, Kapur N (2005) The epidemiology and prevention of suicide by hanging: a systematic review. Int J Epidemiol 34:433–442

    Article  Google Scholar 

  3. Kunii M, Ishida K, Ojima M et al (2020) Bilateral vocal cord paralysis in a hanging survivor: a case report. Acute Med Surg 7:e519

    Article  Google Scholar 

  4. Zatopkova L, Janik M, Urbanova P, Mottlova J, Hejna P (2018) Laryngohyoid fractures in suicidal hanging: a prospective autopsy study with an updated review and critical appraisal. Forensic Sci Int 290:70–84

    Article  Google Scholar 

  5. Gascho D, Heimer J, Tappero C, Schaerli S (2019) Relevant findings on postmortem CT and postmortem MRI in hanging, ligature strangulation and manual strangulation and their additional value compared to autopsy - a systematic review. Forensic Sci Med Pathol 15:84–92

    Article  Google Scholar 

  6. Doberentz E, Markwerth P, Madea B (2019) Differentiation of homicidal or suicidal strangulation. Forensic Sci Int 301:e44–e48

    Article  CAS  Google Scholar 

  7. Kettner M, Potente S, Schulz B, Knauff P, Schmidt PH, Ramsthaler F (2014) Analysis of laryngeal fractures in decomposed bodies using microfocus computed tomography (mfCT). Forensic Sci Med Pathol 10:607–612

    Article  Google Scholar 

  8. Maiese A, Gitto L, dell'Aquila M, Bolino G (2014) When the hidden features become evident: the usefulness of PMCT in a strangulation-related death. Leg Med (Tokyo) 16:364–366

    Article  Google Scholar 

  9. Schulze K, Ebert LC, Ruder TD et al (2018) The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT. Br J Radiol 91:20170479

    Article  Google Scholar 

  10. Kempter M, Ross S, Spendlove D et al (2009) Post-mortem imaging of laryngohyoid fractures in strangulation incidents: first results. Leg Med (Tokyo) 11:267–271

    Article  CAS  Google Scholar 

  11. Decker LA, Hatch GM, Lathrop SL, Nolte KB (2018) The role of postmortem computed tomography in the evaluation of strangulation deaths. J Forensic Sci 63:1401–1405

    Article  Google Scholar 

  12. Garetier M, Deloire L, Dedouit F, Dumousset E, Saccardy C, Ben Salem D (2017) Postmortem computed tomography findings in suicide victims. Diagn Interv Imaging 98:101–112

    Article  CAS  Google Scholar 

  13. Le Blanc-Louvry I, Thureau S, Duval C et al (2013) Post-mortem computed tomography compared to forensic autopsy findings: a French experience. Eur Radiol 23:1829–1835

    Article  Google Scholar 

  14. Naimo P, O'Donnell C, Bassed R, Briggs C (2013) The use of computed tomography in determining developmental changes, anomalies, and trauma of the thyroid cartilage. Forensic Sci Med Pathol 9:377–385

    Article  Google Scholar 

  15. Naimo P, O'Donnell C, Bassed R, Briggs C (2015) The use of computed tomography in determining development, anomalies, and trauma of the hyoid bone. Forensic Sci Med Pathol 11:177–185

    Article  Google Scholar 

  16. Svanholm H, Starklint H, Gundersen HJ, Fabricius J, Barlebo H, Olsen S (1989) Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic. APMIS 97:689–698

    Article  CAS  Google Scholar 

  17. Kanda Y (2013) Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  Google Scholar 

  18. Godin A, Kremer C, Sauvageau A (2012) Fracture of the cricoid as a potential pointer to homicide. A 6-year retrospective study of neck structures fractures in hanging victims. Am J Forensic Med Pathol 33:4–7

    Article  Google Scholar 

  19. Bowen DA (1982) Hanging--a review. Forensic Sci Int 20:247–249

    Article  CAS  Google Scholar 

  20. Elfawal MA, Awad OA (1994) Deaths from hanging in the eastern province of Saudi Arabia. Med Sci Law 34:307–312

    Article  CAS  Google Scholar 

  21. Talukder MA, Mansur MA, Kadir MM (2008) Incidence of typical and atypical hanging among 66 hanging cases. Mymensingh Med J 17:149–151

    CAS  PubMed  Google Scholar 

  22. Ribaute C, Darcourt J, Patsoura S et al (2019) Should CT angiography of the supra-aortic arteries be performed systematically following attempted suicide by hanging? J Neuroradiol. https://doi.org/10.1016/j.neurad.2019.04.001

  23. Murphy SL, Kochanek KD, Xu J, Heron M (2015) Deaths: Final Data for 2012. Natl Vital Stat Rep 63:1–117

    PubMed  Google Scholar 

  24. Latoo M, Lateef M, Nawaz I, Ali I (2007) Bilateral recurrent laryngeal nerve palsy following blunt neck trauma. Indian J Otolaryngol Head Neck Surg 59:298–299

    Article  Google Scholar 

  25. Porr J, Laframboise M, Kazemi M (2012) Traumatic hyoid bone fracture - a case report and review of the literature. J Can Chiropr Assoc 56:269–274

    PubMed  PubMed Central  Google Scholar 

  26. Ramchand T, Choudhry OJ, Shukla PA, Tomovic S, Kuperan AB, Eloy JA (2012) Management of hyoid bone fractures: a systematic review. Otolaryngol Head Neck Surg 147:204–208

    Article  Google Scholar 

  27. Tugaleva E, Gorassini DR, Shkrum MJ (2016) Retrospective analysis of hanging deaths in Ontario. J Forensic Sci 61:1498–1507

    Article  Google Scholar 

  28. Christe A, Thoeny H, Ross S et al (2009) Life-threatening versus non-life-threatening manual strangulation: are there appropriate criteria for MR imaging of the neck? Eur Radiol 19:1882–1889

    Article  Google Scholar 

Download references

Funding

This work was not received any financial support from any company.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan

    Wataru Fukumoto, Hidenori Mitani, Yuka Kuno, Toru Higaki, Fuminari Tatsugami, Yuko Nakamura & Kazuo Awai

  2. Center for Cause of Death Investigation Research, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan

    Wataru Fukumoto, Masataka Nagao & Kazuo Awai

Authors
  1. Wataru Fukumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidenori Mitani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuka Kuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toru Higaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fuminari Tatsugami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuko Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masataka Nagao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kazuo Awai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wataru Fukumoto.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr. Kazuo Awai, Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University.

Conflict of interest

The authors (Kazuo Awai) of this manuscript declare relationships with the following companies: Canon Medical Systems Co. Ltd.

Statistics and biometry

One of the authors (Kazuo Awai) has significant statistical expertise.

The interobserver agreement for detecting laryngohyoid fractures on CT images between the two radiologists was assessed by using the Cohen kappa coefficient of concordance.

Multiple logistic regression analysis was used for factor analysis of laryngohyoid fractures.

Informed consent

This retrospective study was approved by our institutional review board; prior informed consent was waived.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fukumoto, W., Mitani, H., Kuno, Y. et al. Incidence and factor analysis of laryngohyoid fractures in hanging individuals—computed tomography study. Eur Radiol 31, 7827–7833 (2021). https://doi.org/10.1007/s00330-021-07932-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-07932-8

Keywords

Search

Navigation