Homicidal smothering: vital histological confirmation of orofacial injury despite a prolonged post-mortem interval

Homicidal smothering is the deliberate occlusion of the external airways, usually using the hands, pillows, or bedding. Victims are often those who are unable to resist, such as the young or the old. The limited resistance offered by these individuals may result in a comparative lack of injury. We present a case of a 72-year-old female, found deceased on her bed. The case was initially not considered suspicious and a coronial autopsy was performed. Concerns were subsequently raised and the body remained refrigerated. Six months after the initial examination, an opinion was requested as to whether further examination would be worthwhile to consider allegations of deliberate smothering. Review of the scene photographs showed deviation of the nose, eversion of the upper lip, and suspected intra-oral bruising. A bloodstained pillow was adjacent to the face. At the later autopsy, the body was found to show significant post-mortem deterioration and the facial tissues were mummified. The upper lip was excised and routinely processed for histology, sections showing remarkably good tissue preservation and extensive recent bruising, allowing the suspicious lip injuries in the scene photographs to be safely interpreted. This report illustrates the subtle pathological findings apparent in many of these cases and reinforces the need for thorough external examination and correlation with forensic scene investigation. Histological sampling of suspected injuries can be rewarding, even in the presence of severe post-mortem deterioration.