A 20-year study of fatal pressure on the neck in autopsied cases at the Universiti Kebangsaan Malaysia Medical Center

Background: Fatal neck pressure may arise from hanging, ligature strangulation and manual strangulation. The analysis aimed to evaluate the demographic profiles of deadly neck pressure concerning ligature material, its position on the neck and the pattern of neck injuries with the manner of death in autopsied cases at Universiti Kebangsaan Malaysia Medical Center (UKMMC). Materials and Methods: A 20-year retrospective analysis was conducted at UKMMC, where 287 cases were sampled; out of which 267 cases were suicidal hanging, and four were accidental hanging. Only 11 cases of ligature strangulation and five cases were due to manual strangulation. The details were obtained from the autopsy report and IBM SPSS Statistics 28 analysis. Results: This study showed that 210 (73.2%) males and 77 (26. 8%) females with a ratio of 2.7:1 had died of fatal neck pressure. Male dominance (74.5%) was displayed in suicidal hanging, and there was no sex difference in ligature and/or manual strangulation. Ligature and manual strangulation were common in the younger age group. Accidental strangulation in young adults was most probably due to auto-erotic asphyxia. In this study, the youngest was 1 year, while the oldest was 85 years. The most common ligature used in suicidal hanging and homicidal ligature strangulation was hard material. The most typical pattern of the neck finding was facial congestion (71.1%), followed by petechial haemorrhages, neck muscle contusion, hyoid bone fracture, thyroid cartilage fracture and carotid injury (1.7%). Conclusion: Forensic pathologists' experience and autopsy techniques are fundamental in explaining the injury pattern and its correlation with fatality.