In a case of throttling (manual strangulation), the pathologist finds bilateral fractures of the superior cornua of the thyroid cartilage. This specific injury pattern is MOST useful for distinguishing throttling from:

• A Hanging — where superior cornu fractures also occur due to the rope
• B Ligature strangulation — where the anterior cricoid arch is more commonly fractured, not the superior cornua
• C Mugging (choke hold/carotid sleeper) — always causes fractures of the hyoid bone only
• D Smothering — where no laryngeal injuries occur but perioral haemorrhages are seen ✓

Explanation

In manual strangulation (throttling), direct finger pressure on the larynx commonly fractures the superior cornua of the thyroid cartilage (due to compression against the spine) and the hyoid bone. Smothering (obstruction of the nose and mouth) does not produce laryngeal fractures; instead, it shows facial petechiae, perioral contusions, and mucous membrane injuries. Ligature strangulation typically fractures the hyoid body and cricoid cartilage. Hanging may fracture the thyroid cornua but the pattern differs. Therefore, superior cornu fractures strongly favour throttling over smothering.

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

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Written and medically reviewed by the StethoPrep medical team.