- 112 cases; predominantly male (61.6%), mean age 37.3 years; women often strangled by intimate partners, men by acquaintances (p < 0.001).
- Manual strangulation was more common (55.4%) than ligature (40.2%); neck muscle haemorrhage occurred in 85.5 to 88.9% of cases.
- Laryngohyoid fractures found in 51.8%, linked to older age and robbery motive; additional causes of death common, urging systematic autopsy.
J Forensic Leg Med. 2026 Nov 2;124:103297. doi: 10.1016/j.jflm.2026.103297. Online ahead of print.
ABSTRACT
INTRODUCTION: Autopsy-based data on the neck injury patterns and contribution to cause of death in homicidal strangulation remain scarce, particularly in North Africa.
AIM: To investigate the autopsy characteristics of homicidal strangulation and analyze their specific contribution to the cause of death and neck injuries.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
PMID:42994360 | DOI:10.1016/j.jflm.2026.103297
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