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ORIGINAL PROF-2819
ABSTRACT Introduction: There are three types of compression of neck which are of prime
forensic importance (1) Manual strangulation (2) Hanging (3) Ligature strangulation. Ligature
mark is found in the latter two types.1 Ligature mark is a pressure mark on the neck underneath
the ligature. Initially it appears as a pale groove which on drying becomes yellowish brown
parchment like.2,5 Objective: The aim is to study the information provided by a ligature mark
in ligature asphyxial deaths. Methodology: Study Design: A retrospective study on ligature
asphyxial deaths. Setting: Forensic Medicine and Toxicology Departments of King Edward
Medical University, Lahore and Nishtar Medical College, Multan. Period: January, 2012 to
December, 2013. Results: The incidence of violent ligature asphyxial deaths was 4.21% of the
total medicolegal deaths autopsied. Age group 21 to 30 years accounted for the maximum
cases (37.6%). Male: female ratio was 1.02. Nylon rope (44.7%) was the most common ligature
material used. Ligature mark was single in all cases and was situated above thyroid cartilage in
82.92% cases of hanging. In ligature strangulation deaths, mark was one in number in 93.18%
cases and was below thyroid cartilage in 97.72% cases. The manner of death in hanging
was mostly suicidal (90.24%) as compared to homicidal in all cases of ligature strangulation.
Ligature mark was incompletely encircling the neck in 85.36% cases and obliquely present in
100% cases of hanging. In all deaths due to ligature strangulation, it was completely encircling
and transversely present around the neck. Underlying soft tissues of neck were glistening
white in all hanging deaths while it showed extravasations of blood in all ligature strangulation
cases. Conclusions: A meticulous examination of the ligature mark during autopsy, though not
conclusive, can give valuable information that can be very helpful in diagnosing deaths due to
hanging and ligature strangulation.
Key words:
Article Citation: Arif M. Ligature mark on the neck; How elucidative?. Professional Med J
2015;22(6):798-803.
INTRODUCTION
There are three types of compression of neck
which are of prime forensic importance (1)
Manual strangulation (2) Hanging (3) Ligature
strangulation. Ligature mark is found in the latter
two types.1 Ligature mark is a pressure mark
on the neck underneath the ligature. Initially
it appears as a pale groove which on drying
becomes yellowish brown parchment like.2,5
While conducting autopsy on ligature asphyxial
deaths, autopsy surgeon often comes across
cases when the only principle external sign
present is the ligature mark on the neck. It is easy
to diagnose hanging and ligature strangulation
in the presence of the characteristic features of
their ligature mark. However, atypical ligature
marks are also seen which may cause difficulty
in diagnosing hanging and strangulation.
Professional Med J 2015;22(6):798-803.
798
Violent ligature
asphyxial
deaths
85
Percentage of
ligature asphyxial
deaths
4.21%
Age
group
(in
years)
0-10
11-20
21-30
31-40
41-50
>50
Total
(%)
M/F
Ratio
Hanging
Ligature
strangulation
Male
Female
Male
Female
27
(65.85)
14
(34.14)
16
(36.36)
28
(63.63)
0
4
8
7
6
2
0
3
6
2
3
0
1.7
2
4
5
3
2
0
9
13
4
2
0.57
Total (%)
2(2.35)
20(23.5)
32(37.6)
16(18.82)
13(15.29)
2(2.35)
85 (100%)
1.02
Hanging
No (%)
799
Type of neck
compression
Number of turns
1
2
3
Hanging No (%)
41
(100)
34
(82.92)
5
(12.19)
2
(4.87)
37
(90.24)
4
(9.75)
Ligature
strangulation
No (%)
41
(93.18)
3
(6.81)
1
(2.27)
43
(97.72)
44
(100)
Total (%)
82
(96.47)
3
(3.52)
34
(40)
6
(7.05)
45
(52.94)
37
(43.52)
48
(56.47)
Suicidal
Manner of death
Homicidal Accidental
Encirclement
Direction
Internal appearance
Complete
Incomplete
Oblique
Transverse
Glistening white
Extravasation of
blood
Hanging
No (%)
6(14.63)
35(85.36)
41(100)
41(100)
Ligature
strangulation
No (%)
44(100)
44(100)
44 (100)
Total (%)
50(58.8)
35(41.2)
41(48.2)
44(51.76)
41(48.23)
Table-V. Encirclement, Direction and Internal Appearance of Ligature Mark
DISCUSSIONS
The ligature mark is a vital piece of evidence
especially when the actual ligature is not available
for examination.1
In the present study, 4.21% cases out of total
2016 medicolegal autopsies were of hanging and
ligature strangulation which is similar to Indian
studies by Momin et al6 and Sheikh.7 The study
showed maximum number of cases (37.6%) in
21- 30 years age group which is consistent with
observations of Momin et al (40.2%)6, Sheikh
(42.4%)7 and Pravin (39.3%)8 from India. In a study
from Karachi9, there were 37.03% cases between
15-25 years of age which is comparable with the
study. The above findings can easily be explained
by the fact that this age group is the most active
phase of life and is thus more exposed to stress
and strains like marital disharmony, financial
crises, failure of love affairs, unemployment, etc.
Furthermore, there is a transition from students
life, where parents bear most of the expenses/
responsibilities, to practical life where they are
expected to commence their professional career
supporting themselves as well as their families
financially. This is the start of a new chapter in life
Professional Med J 2015;22(6):798-803.
44(51.76)
800
801
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In:
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forensic
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2. Vij K. Asphyxial Deaths. In: Textbook of Forensic
Medicine and Toxicology, principles and practice. 4th
Ed. Elsevier, A division of Reed Elsevier India Private
Limited; 2009. p. 117-190.
www.theprofesional.com
802
21. Khalil ZH, Naeem M, Adil M, Khan MZI, Abbas SH, Alam
N. Asphyxial deaths: a four year retrospective study
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ligature strangulation a comparison of the postmortem findings. Forensic Sci Int2003;137:60-66.
23. Demirci S,Dogan KH, Erkol Z, Gunaydin G. Ligature
strangulation deaths in the province of Konya
(Turkey). J Forensic and Legal Med 2009; 16: 248252.
24. Hata N, Kominato Y, Shimada I, Takizawa H, Fujikura
T, Morita M,et al.Regional differences in homicide
patterns in five areas of Japan. Legal Med2001;3:4455.
Author=s Signature
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