An Audit Into the Incidence of Laryngohyoid Fractures in Suicidal Hangings

Suicide by hanging remains a common modality of death across the globe. Despite this, the reported incidence of laryngohyoid fractures in suicidal suspensions remains widely varied across the current literature. This audit was conducted to benefit from a single institution's standard method of practice, coupled with a sufficiently large enough data set, to draw better conclusions on the incidence of laryngohyoid fractures in such cases and any predicting variables.

Autopsy records for a total of 12 years from January 2011 to May 2023 were examined to identify cases of suicidal hanging and determine the laryngohyoid fracture incidence. A range of subsequent data relating to the deceased, the ligature, the suspension and post-mortem findings were recorded and statistically analysed to identify significant variables associated with the presence of such fractures.

A total of 383 autopsy reports were included. Overall incidence of any laryngohyoid fracture was 59.3%. Thyroid and hyoid fractures were found in 51.4% and 29.2% of these cases, respectively. The most common fracture pattern was fractures of the bilateral superior thyroid horns. Significant associations between fracture incidence and the following variables were identified: ligature type, ligature mark, petechiae, age and height.

This audit highlights the ligature as a potential important predictor in the presence of laryngohyoid fracture. There is a relative paucity of information relating to the ligature used and the incidence of fracture. Future efforts should be focused on prospective and standardised collection of data, with particular focus on the ligature type.