Le Facies sympathique is suggestive of
Correct Answer: Antemortem hanging
Description: Ans. a (Antemortem hanging) (Ref Reddy's essentials of FMT 27th 1299)Postmortem appearance in death due toiianging:# The ligature mark in the neck is the most important and specific sign of death from hanging. The ligature mark is situated above the level of thyroid cartilage between the larynx and the chin in 80 percent cases. In partial hanging, the feet touch the ground.# Le facie sympathique (if the ligature knot presses on cervical sympathetic, the eye on the same side may remain open and its pupils dilated) is seen in antemortem hanging. The eyes are frequently protruded and firmer and the conjunctiva congested, the pupils are usually dilated. Saliva may be found dribbling from the angle of the mouth (due to stimulation of the salivary glands by the ligature).# Seminal emission is common.# In rare cases (5 to 10%), the intima of the carotid arteries show transverse split.# Hyoid bone is fractured in 15 to 20% cases. Are seen in persons above 40 years; involves the great horn at junction of the inner two-thirds and outer one-third.MECHANICAL ASPHYXIAAsphyxial deaths1. Suffocation--Mechanical obstruction to airways other than by hanging, strangulation and throttling. MC cause is inhalation of irritant gas.2. Smothering--Closing the external respiratory orifice by hand or by other means.3. Gagging--Closing mouth and nose with cloth etc., and tying around head or stuffing it into mouth.HANGINGHanging is that form of asphyxia which is caused by suspension of the body by a ligature, which encircles the neck, the constricting force being the weight of the body.In partial hanging, the bodies are partially suspended; the weight of the head (5-6 kg) acts as the constricting force.Topical hanging: In typical hanging, the ligature runs from the midline above the thyroid cartilage symmetrically upward on both sides of neck to the occipital region.Causes of Death1. Asphyxia: A tension of 15 kg on ligature blocks the trachea.2. Venous congestion: The jugular vein is closed by a tension in the rope of 2 kg.3. Combined asphyxia and venous congestion: this is the commonest cause.4. Cerebral anemia: A tension of 4 to 5 kg on ligature blocks carotid arteries, and 20 kg blocks the vertebral arteries.5. Reflex vagal inhibition from pressure on the vagal sheath or carotid bodies.6. Fracture or dislocation of the cervical vertebrae.Fatal period: The usual period is 3 to 5 minutes.Judicial hangingThe cause of death in judicial hanging is fracture dislocation at the level of second and third or third and fourth cervical vertebra.Lynchingis a type of homicidal death by hanging by large group of people.Strangulationis that form of asphyxia which is caused from constriction of the neck by a ligature without suspending the body. It is of two types (1) Strangulation by ligature, and (2) manual strangulation or throttling.The common methods of homicidal strangulation are: (1) Strangulation by ligature, (2) Throttling, (3) Bansdola, (4) Garrotting, and (5) MuggingMugging is homicidal strangulation caused by holding the neck of the victim in the bend of the elbow.Bansdola is a type of homicidal strangulation caused with sticks.Garroting is type of homicidal strangulation caused by twisting a lever like tomiquet.ThrottlingThrottling is manual strangulation. Fracture of the hyoid bone in 30-50% cases. Fracture of the thyroid cartilage and hyoid bone are usually found in above 40 years. Hyoid bone fracture does not occur in choking. It is always homicidal.SuffocationSuffocation is a general term to indicate that form of asphyxia which is caused by deprivation of oxygen, either due to lack of oxygen in the environment or from obstruction of the air-passages.SmotheringSmothering is a form of asphyxia which is caused by closing the external respiratory orifices either by the hand or by any other means, or blocking up the cavities of the nose and mouth by the introduction of a foreign substance, such as mud, paper, cloth, etc.Gaggingis a form of asphyxia which results from forcing a cloth into the mouth, or the closure of mouth and nose by a cloth or similar material, which is tied around the neck.OverlayingIt is a type of smothering. Overlaying or compression suffocation results due to compression of the chest, so as to prevent breathing. Overlaying by mother is common in European countries. The usual findings are those of asphyxia.BurkingIt is a method of homicidal smothering and traumatic asphyxia.Homicidal chokingIn choking, there is obstruction within airways. It is very rare and is practicable only when the victim is an infant or suffering from disability or disease, or under the influence of alcohol.Cafe CoronaryThis is a condition in which a healthy but grossly intoxicated person, who begins a meal, suddenly turns blue, coughs violently, then collapses. Death appears to be due to sudden heart attack, rather than due to asphyxia. A blow on the back or on the sternum may cause coughing and expel the foreign body.Traumatic AsphyxiaTraumatic asphyxia results from respiratory arrest due to mechanical fixation of the chest, so that the normal movement of the chest wall is prevented. Common cause is crushing by falls of earth in a coal mine or during tunneling or in a building collapse. An intense cyanosis of deep purple or purple-red colour of the head, neck and upper chest, above the level of compression is the prominent feature.Sexual AsphyxiaPartial asphyxia causes cerebral disturbance with feeling of sexual gratification. These cases are associated with some form of abnormal sexual behavior, usually masochism and transvestism.
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