Autopsy-Based Indicators of Suicidal Hanging – A Study of Ligature Marks, Salivary Signs, and Parchmentization

Open Access

Abstract

Introduction: Hanging is one of the most common methods of suicide globally and remains a significant public health concern, particularly in South and Southeast Asia, where it accounts for over half of suicide deaths. Forensic evaluation relies heavily on external indicators, such as ligature marks, salivary dribbling, and parchmentization; however, their diagnostic value is debated due to the variable presence and inconsistent reporting across studies. Methods & Materials: This cross-sectional study was conducted at Dhaka Medical College from January to July 2024 and included 177 confirmed suicidal hanging cases, excluding decomposed or uncertain deaths. Data on socio-demographics, ligature marks, salivary dribbling, parchmentization, and other autopsy findings were collected using a structured checklist. Analyses were performed in SPSS 26 using descriptive statistics, Chi-square tests, and logistic regression to identify predictors of tongue bite and salivary dribbling (p < 0.05). Results: Among 177 suicidal hanging cases, most victims were young adults (75.2% ≤30 years), predominantly male (59.3%), and married (63.3%). The ligature mark above the thyroid cartilage was the most frequent finding (100%), and parchmentization was nearly universal (97.2%). Ancillary signs were less common: tongue bite (24.3%) and salivary dribbling (16.4%), though both were significantly associated with younger age and a history of prior suicide attempts. Other features included facial congestion (68.9%), cyanosis (81.9%), tongue protrusion (22.0%), petechiae (15.3%), and rare hyoid bone fractures (5.1%). Conclusion: Suicidal hanging in this series most often affected young, married males and was consistently characterized by a single oblique ligature mark with near-universal parchmentization.