Ligature Strangulation

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In ligature strangulation, the pressure on the neck is applied by a constricting band that is tightened by a force other than the body weight. Virtually all cases of ligature strangulation are homicides. In the authors' experience, ligature strangulation is the most common method of homicidal asphyxia, though the incidence of manual strangulation follows fairly closely. In a study of 133 homicides caused by asphyxia, ligature strangulation accounted for 48 of the deaths; manual strangulation for 41.26 In ligature strangulation, females predominate as victims, though not as much as in the case of manual strangulation. Of the 48 victims of ligature strangulation, 27 were females and 21 males. In the authors' experience, the most common motive for ligature strangulation of females is rape. Suicides and accidents are rare. The mechanism of death is the same as in hanging — occlusion of the vessels supplying blood and thus oxygen to the brain. With constant compression of the carotid arteries, consciousness is lost in 10-15 sec.

In contrast to hanging deaths, the face and neck above the ligature mark appear markedly congested, with confluent scleral hemorrhage and petechiae of the conjunctivae. Fine petechiae might also be present on the skin of the face, especially in the periorbital regions. In the authors' experience, petechiae are present in 86% of the cases of ligature strangulation.26 The presence of a congested face, petechiae, and scleral hemorrhage in ligature strangulation occurs because, unlike in hanging, there is no complete occlusion of the vasculature. Blood continues to go into the head from the vertebral arteries. It cannot escape, however, because of the compressed venous system. This results in increased intravascular pressure, congestion, and rupture of the vessels.

Ligatures used range from electrical cords, neckties, ropes, and telephone cords to sheets and hose. The appearance of a ligature mark on the neck is subject to considerable variation, depending on the nature of the ligature, the amount of the resistance offered by the victim, and the amount of force used by the assailant. The ligature mark might be faint, barely visible, or absent in young children or incapacitated adults, especially if the ligature is soft, e.g., a towel, and removed immediately after death (Figure 8.21). If a thin tough ligature is used, there will be a very prominent deep mark encircling the neck. Initially, it has a yellow parchment-like appearance that turns dark brown.

In ligature strangulation, in contrast to hangings, the ligature mark usually encircles the neck in a horizontal plane often overlying the larynx or upper trachea (Figure 8.22). When a wire or cord is used, it often completely encircles the neck. There might be a break in the furrow, however, usually in the back of the neck, where a hand has grasped the ligature and tightened it at this point. Aside from the ligature mark, abrasions and contusions of the skin of the neck are usually not present. They can occur, however, if the

Figure 8.21 (A, B, C (A) Ligature strangulation with cloth band. Ligature marks on anterior and lateral aspects of neck. (B) Close-up showing vertically oriented pattern of cloth. (C) Poorly defined ligature marks on a young girl strangled with T-shirt (continued).
Ligature Marks Strangulation
Figure 8.21 (continued) (D and E) Elderly man strangled with towel.

assailant places his hands beneath and around the ligature and twists it, tightening it around the neck, or if the victim claws at his neck in an attempt to remove the ligature or relieve the pressure. If there is more than one loop of the ligature around the neck, there could be bruising of the skin if the ligature pinches the skin between two loops. Edema fluid may be present in the nostrils.

Injury to the internal structures of the neck is the exception rather than the rule. In a study of 48 ligature strangulation deaths, fractures of the hyoid or thyroid cartilage were present in only six cases (12.5% of the total cases) — five of the males (23.8%) and one (3.7%) of the females.26 Altogether, there were 12 fractures in the six cases, seven of the hyoid and five of the thyroid cartilage. Four of the victims had fractures of both the thyroid and

Ligature Marks Strangulation

Figure 8.22 Victim strangled with (A) telephone cord and (B) boot lace. Face congested with numerous petechiae. Horizontally oriented ligature mark overlying larynx, encircling neck.

Figure 8.22 Victim strangled with (A) telephone cord and (B) boot lace. Face congested with numerous petechiae. Horizontally oriented ligature mark overlying larynx, encircling neck.

hyoid; two, only the hyoid. The fractures of the thyroid cartilage all involved the superior horns.

Suicide using a ligature is rare. In such cases, the victim usually ties a ligature tightly around the neck (Figure 8.23A). Because some individuals remain conscious for 10-15 sec after complete occlusion of the cartoid arteries, they have sufficient time to tie at least one, if not more, knots. Instead of tying a knot, some individuals tightly wrap a ligature several times around the neck, securing it in place by the overlapping loops. Other individuals use a tourniquet method: a ligature is loosely wrapped around the neck, knotted, and then tightened by a stick inserted beneath the ligature and twisted multiple times. Clothing or the individual's own weight on the stick holds it in place, maintaining the "tourniquet." In one case, an individual used a plastic lock-tie to strangle himself (Figure 8.23B).

Accidental ligature strangulation is rare. It is seen when a tie, scarf, shirt, or other article of clothing gets entangled in a moving machine. Isadora Duncan, the dancer, died of accidental strangulation when a scarf she was wearing became entangled in an automobile wheel.27 Other deaths have involved motorcycles, snowmobiles, ski lifts and massage devices.27

Despite decomposition, ligature marks tend to be well preserved and recognizable. The marks resist decomposition presumably because the

Stocking Strangulation
Figure 8.23 (A) Suicidal ligature strangulation using stocking. Six previous attempts at suicide. (B) Suicidal strangulation using plastic lock-tie.

ligature has compressed the underlying blood vessels, restricting access to the area by the putrefying bacteria. In infants, the elderly, and decomposing bodies, there can be pseudo-ligature marks that suggest strangulation. In infants, pale crease marks between overlapping folds (rolls) of neck skin can be mistaken for ligature marks. This can be further complicated in newborns by the presence of petechiae, which can be normally present in newborns delivered vaginally because of compression of the chest.

A similar picture of pseudo-ligature marks can be seen in the elderly — pale crease marks caused by overlapping rolls of skin, petechiae of the sclerae and conjunctivae (caused by cardiac failure) — with the addition of retro-pharyngeal hemorrhage. Petechiae are often seen in acute cardiac failure, not uncommonly the cause or mechanism of death in elderly individuals. The case that comes to mind is that of an elderly woman found dead in bed with a pillow propping up her head, such that her chin was against her chest. There was a long history of cardiac disease. When the body was examined at the medical examiner's office, there was a horizontal mark across the front of her neck that simulated a ligature. The face above the mark was congested and there were fine petechiae of the sclerae, conjunctivae, and periorbital skin, as well as retropharyngeal hemorrhage. At the time the body was initially autopsied, a full account of the circumstances and scene surrounding the death was unknown. For example, it was not known that the head had been propped up, that there was a long history of cardiac failure, and that the woman died in a room with no windows and with a single entrance that was blocked by a bed in which her bedridden husband slept. Death was, in fact, caused by her long-standing coronary artery disease. The "ligature mark" was just an artifact — a crease caused by the positioning of the head. Pseudoligature marks can also be seen in decomposing bodies with tight collars or other clothing around the neck. The body, as it decomposes, swells around the tight-fitting garment, which produces a deep furrow that simulates a ligature mark.

In victims of homicidal ligature strangulation, hair is often found clutched in the hands. This should be recovered and retained. A control sample of the victim's hair should be obtained for comparison, because the hair found in the hands almost invariably turns out to be that of the victim. Fingernail scrapings or cuttings (the latter are preferred) should be taken to look for tissue of the perpetrator under the nails. Unfortunately, unlike in fiction, such scrapings or cuttings have traditionally been of little help, with foreign tissue rarely identified. With the new STR and mitochondrial DNA techniques, this should change, with a greater success in detecting tissue of an assailant on fingernail cuttings.

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    Why is petechiae seen more commonly in strangulation that suicides?
    7 years ago
  • tarquinia mazzanti
    How to strangle yourself with a ligature?
    7 years ago
    Is scleral petechiae present in a hanging?
    7 years ago
  • Charlie Thompson
    What do ligature marks look like if someone was strangled?
    7 years ago
  • Dehab
    What is "Asphyxia, ligature"?
    7 years ago
  • susanna
    Where to place rope on neck in strangulation?
    7 years ago
  • Savannah Christie
    How painful is death by rope strangulation?
    4 years ago
  • sandro
    How to strangle yourself in bed with rope?
    4 years ago
  • sarah
    Where to tie a knot for strangulation?
    4 years ago
  • Ren
    Where do you place ligature for hanging?
    4 years ago
  • semhar
    How to tie a ligature on anterior tooth?
    3 years ago
  • rita
    When happens in ligature strangulation?
    3 years ago
  • procopio
    How to tie a ligature around your neck?
    3 years ago
  • lydia
    How to ligature asphyxiation?
    2 years ago
  • ermenegildo
    What is ligature neck compression?
    2 years ago
  • nicole
    How death happena in legature compression method?
    2 years ago
  • Miranda
    Can you die from tight scarf around the neck?
    2 years ago
  • tyko
    How do i tie a knot to my neck to strangle?
    2 years ago
  • Hiewan
    What marks are seen if choked to death?
    2 years ago
  • james nation
    Is ligature compression painful?
    2 years ago
  • leila
    How to tie a ligature to kill yourself?
    2 years ago
  • pandora
    Why is petechiae more commonly seen in strangulation as opposed to suicidal hanging?
    2 years ago
    Is ligature strangulation paintful?
    1 year ago
  • Sarama
    How to compleate ligature strangulation?
    1 year ago
  • semhar
    Can u tell how long someone had been hanging by the Ligature Marks?
    7 months ago
  • raymond
    Can ligatures be tightened on the side?
    5 months ago
  • aziza
    What to do if someone ties a ligature around their neck?
    4 months ago
  • jan
    How does a ligature strangulation differ from manual?
    4 months ago
    Can ligature stragulation kill you?
    3 months ago
  • ryley
    Which statement accurately characterizes ligature strangulation?
    2 months ago
  • christian mackenzie
    What is it like to strangle someone to death?
    2 months ago
    Do you wake back up after ligature hanging?
    1 month ago
  • belinda brownlock
    Can carbon monoxide cause petechiae?
    1 month ago
  • George
    Why do pekple put a towel arounf their neck when hanging?
    2 days ago

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