Int J Biol Med Res.

2023 ;14(4):7669-7672
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Original article
A Study of Gross Morphological Differences in Appearance of Ligature Mark in
Post-Mortem Cases of Asphyxial Deaths in a Tertiary Care Centre of Haryana
Kunal Khannaa, *Jitender Kumar Jakhar b Sandeep Kumar Giric Naveen Sharmad Gajender Yadave
a
Associate Professor, Department of Forensic Medicine & Toxicology, Kalpana Chawla Govt. Medical college Karnal, Haryana (132001)
b
Professor,Department of Forensic Medicine & Toxicology, Pt. B. D. Sharma PGIMS, Rohtak, Haryana (124001)
c
Assistant Professor, Department of Forensic Medicine & Toxicology, Kalpana Chawla Govt. Medical college Karnal, Haryana (132001)
d
Assistant Professor, Department of Forensic Medicine & Toxicology, MMCMSR Sadopur, Ambala Haryana (134007)
e
Medical Officer, Department of Forensic Medicine, District Hospital, Rewari, Haryana (123401)

ARTICLE INFO ABSTRACT

Keywords:
Aim & objectives: To study the difference between morphology, pattern and variations in
Ligature
ligature mark in cases of the hanging and ligature strangulation.Material & methods: The
Asphyxia
Autopsy ligature mark was studied in detail in cases of asphyxial deaths due to hanging and ligature
Hanging strangulation brought for the autopsy in the mortuary of a tertiary care centre of Haryana on 64
Ligature Strangulation autopsy subjects. Results: Atotal number of 64 cases were included in the study out which 60
cases were of hanging and 4 cases were of ligature strangulation. The direction of ligature mark
was oblique in all 60 (100%) cases of hanging and transverse in all 04 (100%) cases of
strangulation. The ligature mark was interrupted in 43 (72%) cases of hanging, continuous in
17 (28%) cases of hanging whereas interrupted in 02 (50%) cases while continuous in 02
(50%) cases of ligature strangulation. The ligature mark was situated above thyroid cartilage in
44 (73%) cases and at the level of the thyroid cartilage in 16 (27%) cases of hanging while it was
below the level of thyroid cartilage in all 04 (100%) cases of ligature strangulation.Conclusion:
Theobliquity of ligature mark is one of the best measure to differentiate hanging and ligature
strangulation. However, discontinuation, interruption and position of ligature mark either
above or at the level of thyroid cartilage also strongly suggests hanging.

c
Copyright 2023 BioMedSciDirect Publications IJBMR - ISSN: 0976:6685. All rights reserved.

1. Introduction
Asphyxia is derived from Greek word and it literally means Materials and Methods:
pulselessness [1].It can be categorised into two broad groups;
The prospective observational study was carried out during
mechanical and non-mechanical. Mechanical asphyxia means that
the medico-legal autopsies on the cases of death due to hanging
the flow of air into the body is interfered through some physical
and ligature strangulation conducted in the Department of
impediments and is considered the most common type in medico-
Forensic Medicine and Toxicology, Post Graduate Institute of
legal practice [2].Constriction around the neck plays a major role
Medical Sciences (PGIMS), Rohtak (Haryana) from the year 2018
in producing mechanical asphyxia. Hanging and ligature
to 2021. A total of 64 post-mortem cases with alleged history of
strangulation, both are examples of asphyxial fatalities [3].
hanging and ligature strangulation brought for autopsy were
In cases of hanging or ligature strangulation, there will be considered. Bodies with putrefactive changes and all the cases of
evidence of ligature mark around the neck [4].Ligature mark is an strangulation death other than ligature strangulation were
important finding when ligature material is not available. The excluded from the study.
most important findings in a ligature mark are level,
Informed consent was taken from the next of kin of the
discontinuities and obliquity, which may differentiate hanging
deceased. A thorough external examination was conducted in the
from ligature strangulation [5].The aim of present study was to
mortuary with emphasis over ligature mark and ligature material.
find the morphological differences in ligature mark in cases of
Routine instruments and material of dissection were used for
death due to hanging and ligature strangulation.
internal examination of body.
* Corresponding Author : Jitender Kumar Jakhar
Professor,Department of Forensic Medicine & Toxicology,
Pt. B. D. Sharma PGIMS, Rohtak, Haryana (124001)
jjakhar2008@yahoo.com

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 Akshath K S et al./Int J Biol Med Res.14(4):7669-7672
7670

Results: TABLE-II. DISTRIBUTION OF CASES AS PER PRESENCE OR

ABSENCE OF LIGATURE MATERIAL IN SITU
Out of studied 64 death cases, 60 were of hanging while 4 were of
ligature strangulation. 51 (85%) deaths by hanging and 02 (50%)
deaths by ligature strangulation were reported to be in 11-40 years
of age (Table-I). The ligature material around the neck was absent in
39 (65%) cases of hanging and was present in 21 (35%) cases. It was
absent in all 04 (100%) cases of strangulation (Table-II, Figure-1).
The colour of ligature mark was observed to distinguish between
hanging and ligature strangulation. Reddish brown ligature mark
was present in 44 (73%) cases, yellowish brown in 08 (15%) cases
and pale yellow in 04 (07%) cases of hanging. It was hypo-
pigmented/scabbed in 04 (07%) cases of delayed deaths due to
hanging. However, it was reddish brown in all 04 (100%) cases of
TABLE-III: DISTRIBUTION OF CASES AS PER CHARACTERS OF
strangulation (Figure-2).
L I G AT U R E M A R K I N H A N G I N G A N D L I G AT U R E
The width of ligature mark was between 1 to 3 cm in 44 (73%) STRANGULATION.
cases, more than 3 cm in 09 (15%) cases and less than 01 cm in only
07 (12%) cases of hanging. The width was between 1 to 3 cm in 02
(50%) cases while it was less than 1 cm and more than 3 cm in 1
(50%) case each of strangulation (Figure-3).
Various characters of ligature mark were recorded at the time of
autopsy in cases of hanging and ligature strangulation (Table-III).
Direction of ligature mark was oblique in 60 (100%) cases of hanging
and transverse in all 04 (100%) cases of strangulation. Continuity of
ligature mark was interrupted in 43 (72%) cases of hanging,
continuous in 17 (28%) cases of hanging whereas it was interrupted
in 02 (50%) cases while continuous in 02 (50%) cases of
strangulation. Parchmentization of ligature mark was present in 54
(90%) cases of hanging while it was absent in 6 (10%) cases of
hanging whereas present in 02 (50%) cases while absent in 02
(50%) of strangulation. The position of ligature mark in respect of
thyroid cartilage was situated above in 44 (73%) cases and over
thyroid cartilage in 16 (27%) cases of hanging while it was below
thyroid cartilage in all 04 (100%) cases of strangulation. Knot
placement was observed on back of neck in 29 (48%) cases, on right
side in 16 (27%), on left side in 13 (22%), below chin in 02 (03%)
cases while it was on back of neck in all 04 (100%) cases of
strangulation (Figure-4).

TABLE-I: AGE AND SEX WISE DISTRIBUTION OF CASES.

 Akshath K S et al./Int J Biol Med Res.14(4):7669-7672
7671

Discussion:
The ligature mark in hanging and ligature strangulation needs
detailed and extensive examination. Inspection, palpation and
internal examination have to be carried out in an orderly manner.
The nature and texture of ligature material also plays a vital role in
correlating the findings in respective cases.6
In the present study, it is observed that maximum 24 (40%) cases
of hanging were from the age group of 21 to 30 years followed by 17
(28%) cases of the age group 31 to 40 years. The above findings can
easily be explained by the fact that 21 to 30 years of age group is most
susceptible to frustration in life as a result of multiple factors such as
failure of love affairs, stressful marital life, dowry, financial crunch
and pressure of making a good career after completion of studies etc.
It is also observed that maximum number 02 (50%) cases of
strangulation were from age group 41 to 50 years, the age group
having more financial disputes. It is observed that majority of deaths
due to hanging were of males 47 (78%) as compared to females 13
(22%). In deaths due to strangulation also males were dominant i.e.
03 (75%) and female was 01 (25%). Males outnumbered the females
in the present study. Male preponderance can be explained by the
fact that in Indian society the male members are more expected to
bear all the responsibilities. So, they have the dual pressure of career
and family responsibilities. These findings are similar in studies
done by Rawat V et al (2015) [7] and Rangaiah YKC et al (2015) [8].
Reddish brown ligature mark was present in 44 (73%) cases of
hanging and all 04 (100%) cases of strangulation followed by
yellowish brown in 08 (15%) cases of hanging. It was pale yellow in
04 (7%) cases of hanging. The colour of ligature mark depends
largely upon the duration of suspension of the body and nature of the
ligature material used. Reddish brown colour of ligature mark is the
most common and reflects the ante-mortem nature of ligature mark
though other type of coloured ligature mark are also present in ante-
mortem hanging. Similar findings were observed by Pal SK et al
(2018) [9].
The study depicts that width of ligature mark was between 1 to 3
cm in 44 (73%) cases, more than 3 cm in 09 (15%) cases and less
than 01 cm in only 07 (12%) cases of hanging. Width was between 1
to 3 cm in 02 (50%) cases of strangulation while it was less than 1 cm
(25%) and more than 3 cm in 1 (25%) case each. In this study the
width of the ligature material can be categorised into three groups;
narrow when the width is <1 cm, medium when the width is between
1-3 cm and broad when the width is >3 cm. The most common width
in this study was the medium between 1-3 cm in both hanging and
strangulation cases. This shows the most common width of ligature
materials used in cases of hanging and strangulation.
It is observed that the direction of ligature mark was oblique in
all 60 (100%) cases of hanging and transverse in 04 (100%) cases of
strangulation. The direction of ligature mark is considered from the
position of the knot towards most prominent area of ligature mark
[4]. Obliquity is the most consistent feature and plays an important
role in describing cause of death and differentiates between hanging
and strangulation. In the continuity of ligature mark, it is found that it
was interrupted in 43 (72%) cases, continuous in 17 (28%) cases of
hanging and interrupted in 02 (50%) cases while continuous in 02
(50%) cases of strangulation. In cases of hanging, similar findings
were observed by Patel et al (2013) [10], Prasad et al (2016) [6], Rao
D (2016) [11] and Sharma et al (2018) [3]. The higher incidence of
incomplete ligature mark in cases of hanging was observed in most
of the studies with same observation of this study. Continuous
 Akshath K S et al./Int J Biol Med Res.14(4):7669-7672
ligature mark in cases of hanging could be due to slip knot allowing to
completely encircling of neck by the ligature material. Discontinuity
of ligature mark is strongly suggestive of hanging but it neither
confirms nor rule out strangulation. In the present study in 02 (50%)
cases of strangulation, it was continuous. This is because in one case
it was interrupted by the hairs of female and in another case, the
strangulation was entangling of clothes in machinery. Patel et al
(2013) [10] in 66.6% cases and Singh et al(2018) [12] in 10 % cases
of strangulation observed the continuity of ligature mark.
Parchmentization of ligature mark was present in 54 (90%)
cases of hanging while it was absent in 6 (10%) cases. It was present
in 02 (50%) cases of strangulation while absent in 02 (50%) cases of
strangulation. Parchmentization is the thinning and hardening of
tissues beneath the ligature mark in which it is converted to
parchment paper like. It depends upon multiple factors such as
ligature material left in-situ, post-mortem interval and temperature
of environment etc. Higher temperature favours parchmentization.
Rawat V et al (2015) [7] and Sharma et al (2018) [3] observed the
colour and parchmentization as a single parameter though these are
different entity.
The position of ligature mark in respect to thyroid cartilage is
also observed in this study. It was situated above the level of thyroid
cartilage in 44 (73%) cases and over the thyroid cartilage in 16
(27%) cases of hanging. It is a well-known fact that the ligature mark
of hanging and strangulation are not found at same level. Ligature
mark in cases of hanging is situated higher in the neck usually above
the thyroid cartilage. Where suspension is low; the resulting mark
may be set at a lower level typically immediately above or below the
thyroid cartilage. In cases of hanging, the presence of ligature mark
above the thyroid cartilage is because of the fact that the ligature
material slides upward and constriction force around the neck is
applied in upward direction due to weight of the body. Several
studies have reported similar findings with ligature mark below the
level of thyroid cartilage in 02 to 07 % cases of hanging as observed in
the present study [6,11]. This can be found where the victim makes a
larger loop of ligature material keeping the ligature mark below
thyroid cartilage. In present study, the ligature mark was present
below the level of thyroid cartilage in all 04 (100%) cases of
strangulation which is contrary to the study done by Patel et al
(2013) [10] and Kumar V et al (2017) [13]in which ligature mark in
strangulation was found at the level of thyroid cartilage in 100 % and
87.5% cases respectively.
It is observed that in cases of hanging, placement of knot was on
the back of neck in 29 (48%) cases, on right side in 16 (27%), on left
side in 13 (22%), below chin in 02 (03%) cases while it was on back
of neck in all 04 (100%) cases of strangulation. Pal SK et al (2018) [9]
observed that knot was observed on left side of neck in 61 (50%)
cases, on right side of neck in 29 (23.77%) cases, on front of neck in 7
(5.73%) cases and nape/backside in 5 (4.09%) cases of hanging.
Reddy TTK et al (2019) [14] found position of the knot in most cases
of hanging over right and left side of neck 45% and 25% respectively.
Conclusion:
In this study, obliquity of mark is the best measure for
differentiation of hanging and ligature strangulation as it is present
in all cases of hanging and absent in all cases of strangulation.
Horizontal ligature mark is a better measure for diagnosis of
strangulation as it was present in all cases of this study. Discontinuity
of mark also strongly suggests hanging as it is present in most cases
of hanging of this study though it may present in strangulation. In
this study, ligature mark was situated above the level of thyroid
gature material is also recommended with this study.
7672
cartilage in most cases of hanging and below the thyroid cartilage in
all cases of strangulation. Reddish brown ligature mark is more
suggestive of ante-mortem phenomenon rather than differentiation
of hanging and strangulation as comes out in this study.
Suggestions: In cases where the ligature material is not present
at the time of post-mortem examination, using a cellophane tape
over the ligature mark and analysing under comparative microscope
to corroborate with the li
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