Homicidal strangulation in Northern Tunisia: A 17-year autopsy-based study

Autopsy-based data on the neck injury patterns and contribution to cause of death in homicidal strangulation remain scarce, particularly in North Africa.

To investigate the autopsy characteristics of homicidal strangulation and analyze their specific contribution to the cause of death and neck injuries.

This was a retrospective descriptive study including all cases of homicidal strangulation autopsied at the department of legal medicine of Charles Nicolle hospital between, 2005 and 2021.

A total of 112 cases of homicidal strangulation were identified (male: 61.6%; mean age: 37.3 ± 25.4 years). Female victims were most often strangled by an intimate partner (48.9%), males by an acquaintance (37.7%) (p < 0.001). Manual strangulation (55.4%) was more common than ligature strangulation (40.2%). Neck muscle hemorrhage was observed in 88.9% of ligature and 85.5% of manual strangulation cases. Fractures of the thyroid cartilage, the hyoid bone, or both structures were identified in 51.8% of cases, most commonly involving the left hyoid horn and the right superior thyroid horn (8.9% each), and were significantly more frequent in older victims (49.4 ± 22.2 vs. 24.3 ± 22.3 years, p < 0.001) and in robbery-motivated assaults than in other known motives (94.1% vs. 50.0%, p < 0.001). An additional cause of death was found in 62 cases (55.4%), most commonly blunt force trauma (n = 38), followed by sharp force trauma (n = 12), and was more frequently observed in ligature (57.8%) than manual strangulation (51.6%) (p < 0.001).

Laryngohyoid fractures varied with victim age and assault motive rather than strangulation method, while additional causes of death were a common finding, highlighting the need for a thorough, systematic autopsy approach.