ANATOMY OF THE HYOID BONE AND ITS FORENSIC SIGNIFICANCE IN STRANGULATION CASES

Abstract

Background: The hyoid bone is a small but vital structure situated in the anterior neck, serving as an important landmark in cases of asphyxial deaths. Its fracture is often regarded as a crucial indicator of manual strangulation, though the finding must be carefully interpreted in relation to age, ossification, and type of force applied. Understanding the anatomical variations and fracture patterns of the hyoid bone provides valuable insights in differentiating between various forms of neck compression deaths.

Methodology: This descriptive and observational study was carried out at Khairpur Medical College Khairpur Mir's over a period of one year, from January 2023 to December 2023, on 72 medicolegal autopsy cases of suspected strangulation. The hyoid bone, along with adjacent laryngeal structures, was carefully dissected and examined for shape, ossification status, fusion, and fracture. Associated soft tissue and histological changes were also assessed. Data were statistically analyzed using the Chi-square test, and a p-value less than 0.05 was considered significant.

Results: Fractures of the hyoid bone were observed in 50% of the cases, most frequently involving the greater horns. The U-shaped configuration was predominant (72.2%), and complete fusion between the body and greater cornua was seen in 55.6%. A significant correlation was noted between fusion status and fracture incidence (p = 0.012), and between type of strangulation and fracture presence (p = 0.001). Fractures were most common in older individuals and in cases of manual strangulation, whereas younger victims and ligature strangulations showed fewer fractures. Soft tissue hemorrhage and histological evidence of bleeding confirmed the antemortem nature of most injuries.

Conclusion: The study highlights the forensic value of examining the hyoid bone in deaths due to neck compression. The incidence and pattern of hyoid fractures depend strongly on age, ossification, and mechanism of strangulation. While fracture presence supports a diagnosis of manual strangulation, its absence does not exclude asphyxial death. A comprehensive evaluation of bony, soft tissue, and histological findings is essential for accurate interpretation in forensic investigations.