Forensic Medicine · Asphyxial Deaths (Mechanical Asphyxia, Drowning, Smothering)

In hanging, the ligature mark characteristically runs UPWARD toward the point of suspension in a non-continuous oblique manner, leaving a pale furrow with peripheral ecchymoses. In contrast, which feature BEST differentiates strangulation by ligature from hanging?

  • A Petechial haemorrhages above the ligature
  • B Ligature mark is horizontal, continuous, and situated below the thyroid cartilage
  • C Presence of cadaveric lividity in lower limbs
  • D Fracture of hyoid bone
Correct answer: B. Ligature mark is horizontal, continuous, and situated below the thyroid cartilage

Explanation

In strangulation by ligature, the mark is typically horizontal (perpendicular to the long axis of the neck), continuous (encircling 360°), deeply placed below the thyroid cartilage at the level of the trachea, with marked ecchymosis. In hanging, the groove is oblique, directed upward toward the knot (inverted V pattern), non-continuous (gap at the knot side), and lies above the thyroid cartilage at the chin level. Petechiae above the mark can occur in both, though more common in strangulation. Hyoid fracture occurs in both but more commonly in manual strangulation.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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