Balzo Giovanna Del, Pelletti Guido, Raniero Dario, Farinelli Alessia, Uberti Andrea, Vermiglio Elisa, Molteni Gabriele, Nocini Riccardo, Gobbo Stefano, Taus Francesco, Eccher Albino, Luchini Claudio, Brunelli Matteo
Department of Diagnostics and Public Health, University of Verona, Italy.
Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Italy.
Adv Clin Exp Med. 2025 Mar;34(3):327-335. doi: 10.17219/acem/186560.
There are no unequivocal histopathological findings for the diagnosis of fatal asphyxia due to neck compression. From the observation of a series of asphyxiation cases, we noted, during microscopic analysis, a high frequency of "detachment" of soft tissues from the hyoid bone. This specifically refers to the presence of an optical space between the surface of the hyoid bone and soft tissues.
We aimed to evaluate the detachment of soft tissues from the hyoid bone as specific histological evidence of death due to strangulation asphyxia.
Ten blocks were taken from deaths due to external mechanical compression of the neck (strangulation asphyxia, group A), 22 blocks were taken from deaths for other causes without trauma to the neck (group B), and 38 blocks were obtained from living subjects that have undergone laryngectomies (group C). The presence/absence of detachments were compared between the 3 groups (A, B and C) using Fisher's exact test.
The detachment of soft tissues from the hyoid bone was observed in 5 cases (50%) in group A, 6 cases (27.2%) in group B, and 17 cases (44.3%) in group C. The sensitivity and specificity of the presence of the detachment in group A were 0.5 (95% confidence interval (95% CI): 0.38-0.62) and 0.57 (95% CI: 0.45-0.69), respectively. The comparison between the 3 groups and the presence/absence of soft tissue detachment showed no statistically significant differences between the groups (p = 0.329), clarifying that soft tissue detachment is a nonspecific variable for all 3 situations.
Detachment of soft tissues has poor value as a single element to favor the diagnosis of asphyxia due to violent compression of the neck and should be interpreted as an artifactual finding, unrelated to the neck injury or injury vitality.
对于因颈部受压导致的致命性窒息，尚无明确的组织病理学诊断依据。通过对一系列窒息病例的观察，我们在显微镜分析过程中注意到，软组织与舌骨之间出现“分离”的频率较高。这具体是指舌骨表面与软组织之间存在光学间隙。
我们旨在评估软组织与舌骨的分离情况，将其作为勒颈窒息导致死亡的特异性组织学证据。
从因颈部外部机械压迫致死（勒颈窒息，A组）的病例中获取10个组织块，从无颈部创伤的其他原因致死的病例中获取22个组织块（B组），并从接受过喉切除术的活体受试者中获取38个组织块（C组）。使用Fisher精确检验比较三组（A、B和C）之间是否存在分离情况。
A组5例（50%）观察到软组织与舌骨分离，B组6例（27.2%），C组17例（44.3%）。A组中分离情况的敏感性和特异性分别为0.5（95%置信区间（95%CI）：0.38 - 0.62）和0.57（95%CI：0.45 - 0.69）。三组之间以及软组织分离情况的比较显示，组间差异无统计学意义（p = 0.329），这表明软组织分离对于所有三种情况而言都是非特异性变量。
软组织分离作为支持颈部暴力压迫导致窒息诊断的单一因素，价值不大，应被解释为一种人为假象，与颈部损伤或损伤的活力无关。
