Self-induced vomiting as a probable mechanism of an isolated hyoid bone fracture

Fractures of the laryngeal skeleton (hyoid bone and thyroid horns) are an important finding in a forensic autopsy because they are almost always caused by significant trauma and often are relevant in determining the cause and manner of death. In the forensic setting, these injuries are seen in some hangings and more frequently in manual strangulation. Less common mechanisms include direct blows, "choke holds," and hyperextension of the neck. We present a case of a 37-year-old woman who died of complications of acute ethanol intoxication. The case involves an incidental hyoid bone fracture unrelated to the cause of death as well as facial petechiae. After review of all of the medical records, autopsy findings and scene/police investigations-the key findings of facial petechial hemorrhages and hyoid bone fracture are best attributed to the mechanism of self-induced vomiting. This case emphasizes the importance of synthesizing autopsy findings with the patient's medical and social history to avoid unnecessary investigation or prosecution. This is the second known case of this novel mechanism of hyoid bone fracture in the medical literature and the first in the forensic literature.