Manual strangulation injuries of the larynx

Laryngeal injuries secondary to manual strangulation are seen more often by the forensic pathologist than by the otolaryngologist. Forces sufficient to cause thyroid and cricoid cartilage fractures are usually sufficient to cause acute asphyxia and death. However, due to the static nature of the compressive forces applied in strangulation, fractures of the cartilaginous framework may occur without obvious mucosal disruption or submucosal hematoma formation. If the victim survives the initial assault and the injuries go unrecognized and untreated, delayed life-threatening airway obstruction of long-term vocal dysfunction may result. Computed tomography seems to be an excellent noninvasive technique to evaluate and verify cartilaginous laryngeal fractures and soft-tissue injury. Recognition of the potential for such injuries is the key to management and treatment.