Background

All critical structures (blood flow and return; muscular and bony support; air entry and exit; alimentary system entrance) that the body requires to function, even at the most basic level, travel though the neck. However, the neck has a relatively small diameter and is exposed to the environment without any protective shielding; accordingly, it is vulnerable to numerous life-threatening injuries. Disruption of this critical location, such as occurs with strangulation or hanging, can lead to disability and even death.

Strangulation causes death and disability in either of two ways: (1) asphyxia through closure of air passages or (2) occlusion of the blood vessels that supply the brain in the neck as a consequence of external pressure. Hanging is the suspension (complete or incomplete) of a person's body, with compression due to the body's own weight. What many people consider to be hanging is not actually hanging, in that death occurs by fracture or dislocation rather than asphyxia.^[1]

Evidence of strangulation includes the following^{[2, 3]}:

Finger marks around the neck
Bruising
Coughing
Stridor
Change in voice
Facial/subconjuctival petechiae
Facial plethora
Laryngeal tenderness^[4]

Evidence of hanging includes the following^{[5, 6, 7, 3]}:

Ligature marks around the neck
Use of a belt, rope, or cord
Facial/subconjuctival petechiae

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