Study of endolaryngeal structures by videolaryngoscopy after hanging: A new approach to understanding the physiopathogenesis

Duband, S.; Timoshenko, A.P.; Mohammedi, R.; Prades, J.-M.; Barral, F.-G.; Debout, M.; Péoc’h, M.

doi:10.1016/j.forsciint.2009.07.015

« Previous Next »Forensic Science International
Volume 192, Issue 1 , Pages 48-52, 20 November 2009

Study of endolaryngeal structures by videolaryngoscopy after hanging: A new approach to understanding the physiopathogenesis

S. Duband
- Department of Forensic Medicine, Saint-Etienne University Hospital Center, Bellevue Hospital, 42055 St-Etienne, Cedex 2, France
- Department of Pathology, Saint-Etienne University Hospital Center, North Hospital, 42055 St-Etienne, Cedex 2, France
- Corresponding author at: Department of Forensic Medicine, University Hospital Center of Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France. Tel.: +33 (0)4 77 12 05 23; fax: +33 (0)4 77 12 09 16.
A.P. Timoshenko
- Department of Otolaryngology-Head and Neck Surgery, Saint-Etienne University Hospital Center, North Hospital, 42055 St-Etienne, Cedex 2, France
- Department of Anatomy, Jacques Lisfranc Faculty of Medicine, Jean Monnet University, 15 rue Ambroise Paré, 42023 St-Etienne, Cedex 2, France
R. Mohammedi
- Department of Radiology, Saint-Etienne University Hospital Center, Bellevue Hospital, 42055 St-Etienne, Cedex 2, France
J.-M. Prades
- Department of Otolaryngology-Head and Neck Surgery, Saint-Etienne University Hospital Center, North Hospital, 42055 St-Etienne, Cedex 2, France
- Department of Anatomy, Jacques Lisfranc Faculty of Medicine, Jean Monnet University, 15 rue Ambroise Paré, 42023 St-Etienne, Cedex 2, France
F.-G. Barral
- Department of Radiology, Saint-Etienne University Hospital Center, Bellevue Hospital, 42055 St-Etienne, Cedex 2, France
M. Debout
- Department of Forensic Medicine, Saint-Etienne University Hospital Center, Bellevue Hospital, 42055 St-Etienne, Cedex 2, France
M. Péoc’h
- Department of Forensic Medicine, Saint-Etienne University Hospital Center, Bellevue Hospital, 42055 St-Etienne, Cedex 2, France
- Department of Pathology, Saint-Etienne University Hospital Center, North Hospital, 42055 St-Etienne, Cedex 2, France
- Tel.: +33 (0)4 77 12 05 23; fax: +33 (0)4 77 12 09 16.

Received 20 October 2008; received in revised form 16 July 2009; accepted 21 July 2009. published online 21 August 2009.

Abstract

Purpose

To evaluate laryngoscopic findings in hanging cases and to compare them with magnetic resonance imaging (MRI) and forensic autopsy results.

Materials and methods

Postmortem nasolaryngofibroscopy and MRI of five people who died from hanging were performed. Three people who died from other causes than hanging were also examined with a flexible laryngofibroscope. The results were compared with injuries discovered during forensic autopsy.

Results

In all five hanging cases, laryngofibroscopic investigation showed a vocal fold position in complete adduction confirmed by MRI. This position did not seem to be influenced by the intensity of the forces applied to neck or postmortem delay and cadaveric phenomena. The vocal cords of the three non-hanging deceased were found in the intermediate position. These findings could suggest that pressure applied to the cervical nervous and cartilaginous structures or their elongation during hanging could lead to closure of the glottis with vocal cord adduction maintained after death.

Conclusion

Laryngofibroscopic examination in hanging cases could be very useful in confirming the vital character of the hanging and understanding asphyxial phenomena in incomplete suspension without laryngeal crush.

Keywords: Hanging, Nasolaryngofibroscopy, Larynx, Vocal cords, Vocal cords position, Forensic interest