Ligature marks with intermittent abrasions on the skin of the neck is typical in hanging and strangulation. In case of strangulation with a ligature, in addition to the typical ligature mark with abrasions there should be bruises on the skin. In case of strangulation by some hard materials like a rod, there will be extensive injuries over the surface of the neck, which may include abrasions, contusions, and lacerations. These injuries may be of any dimension and may be placed at any level or site of the neck, but are most commonly present in front. In case of throttling, there will be abrasions and bruises representing the nail scratches and finger tip pressures, the sites and numbers of which will vary according to different influencing factors.
In the subcutaneous tissue, the effect of ligature material compressing the neck is reflected by drying, whitening and glistening of the tissue, as is seen in case of hanging. But in case of strangulation by ligature, instead of drying and glistening, the subcutaneous tissue may appear contused. In case of strangulation by any other method, there should be gross damage to the soft tissue of the neck, which is most marked in case of throttling and strangulation by any hard blunt substance. In violent asphyxial deaths, there may be laceration of the carotid sheath (Strangulation by ligature) and transverse tear of the intima of the carotid artery (hanging). Among other injuries (related to violent asphyxia) in neck, there may be fracture of the hyoid bone (hanging and throttling, in victims above the age of 40 years), fracture of thyroid cartilage (strangulation), fracture of tracheal rings (hanging and strangulation) and fracture and dislocation of the 2nd/3rd cervical vertebrae including bruise and laceration of the spinal cord with the covering meninges (judicial hanging). In violent asphyxial deaths injury to the stemo-mastoid muscles and contusion of the posterior wall of the oesophagus may appear as important findings.
Apart from the injuries due to the violent asphyxiation, there may be sharp cut or stab injuries related to suicidal and homicidal deaths. Chop wounds on any side of the neck are almost always homicidal.
Decapitation cuts at the level of the neck may be along with homicidal cut throat or may be entirely post-mortem in nature, where, after killing the victim by some other means, the body is decapitated.
Decapitation should compulsorily suggest homicidal nature of the death except when this occurs due to certain machinaries, or over a railway track, when this may be accidental also.
In the neck, incised or cut injuries may be either suicidal or homicidal in nature. Whereas incised wounds involving the front can be suicidal or homicidal, those on the back and many of the others, placed on either or both sides, go in favour of being homicidal in nature. Stab injuries over the neck are mostly homicidal in nature. Chop wounds are homicidal irrespective of the site and level. These are also, usually more than one in number.
Firearm wounds at the upper part of the neck i. e., below the chin and the mandible go strongly in favour of being suicidal in nature, particularly if these are contact wounds. Any other type of firearm wound at any other site goes in favour of being homicidal in nature.