Kunz S N, Jónasson J G, Rúnarsdóttir R
Department of Forensic Pathology, Landspitali University Hospital, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Pathology, Landspitali University Hospital, Iceland.
J Forensic Leg Med. 2019 Aug;66:95-99. doi: 10.1016/j.jflm.2019.06.014. Epub 2019 Jun 22.
Intense blunt compression trauma to the neck can result in subcutaneous, intramuscular or laryngeal mucosa bleedings of different intensity. While these findings can easily be detected through a layer-wise dissection of the neck muscles and soft tissue during autopsy, it can be difficult to distinguish between peri-/post- and ante mortem hemorrhages solely based on macroscopic findings. Especially when an initial preliminary diagnosis is required, possible artifacts have to be excluded. The study at hand examines possible peri- and post mortem hemorrhages in the anterior neck after NorMors™ chin-collar application. In routine clinical and forensic autopsy cases, where such a chin-collar has been placed around the neck of the deceased in close proximity after death, focus was directed to the soft tissue and muscles of the neck. The results of our analysis could prove that the use of chin-collar shortly within the first 1 ½ hours after death applies just enough pressure to the neck to be able to cause superficial hemorrhages within the surface of the sternocleidomastoid muscles, which can mimic vital compression trauma injuries. Based on location, morphological outlines and intensity of the injuries, it is possible to correlate them with the position of the applied collar. Together with histological analyses, asphyxia by a second party involvement can be excluded. However, the application of chin-collars should be prohibited in any case, where an autopsy might be performed.
颈部受到强烈钝性压迫创伤可导致不同程度的皮下、肌肉内或喉黏膜出血。虽然这些发现可在尸检时通过逐层解剖颈部肌肉和软组织轻易检测到，但仅基于宏观发现很难区分生前和死后出血。特别是在需要初步诊断时，必须排除可能的假象。本研究探讨了在应用NorMors™ 下颌托后颈部前方可能出现的生前和死后出血情况。在常规临床和法医尸检案例中，若在死后不久将这种下颌托紧贴死者颈部放置，重点则放在颈部的软组织和肌肉上。我们的分析结果可以证明，在死亡后的最初1个半小时内不久使用下颌托，会对颈部施加足够的压力，从而能够在胸锁乳突肌表面引起浅表出血，这可能会被误诊为生前压迫创伤损伤。根据损伤的位置、形态轮廓和严重程度，可以将它们与所使用下颌托的位置相关联。结合组织学分析，可以排除他人参与导致窒息的情况。然而，在任何可能进行尸检的情况下，都应禁止使用下颌托。
