Incomplete Decapitation Complicating a Suicidal Hanging: 2 Cases and Review of the Literature

Abstract

Complete or incomplete decapitation is a rare complication of suicidal hanging.
We report two cases of incomplete decapitation complicating two suicidal hanging autopsied in the Forensic
Medicine department in the Hospital Charles Nicolle of Tunis.
The first case is an 80-year-old man found hanged in a balcony in the first floor with a rope. The second case
is 49-year-old man found hanged in the escalators inside his house with a rope.
The external examination found in both cases a cervical margin without skin dilacerations.
On the Autopsy, we found in both cases a vascular section with multiple fractures of the larynx cartilages. In
the first case was observed a fracture of C3 with a disjunction of the inter vertebral disc C2-C3, and in the second
case a disjunction of the inter vertebral disc C4-C5. A section of the spinal cord was also present in both cases.
Hanging is frequently associated with soft tissue lesions, larynx cartilages fractures are frequent but vertebral
fractures are rare.
The mechanism of decapitation complicating hanging is a traction of the neck associated to a constriction force.
Biomechanics studies show that the most important factors in the occurrence of decapitation are the weight of
the body and the distance of the fall associated to the elasticity of the rope.