Downloaded from http://journals.lww.com/amjforensicmedicine by zKJn4tZhFusbzZVlm0SLDu7zc3VV8n/QQbqRcaTzECuaZPCxVG4+7QSPjrgFkainxgGwK8IYK6bk/fXIvkWj4QLhZKQBigapiv90AbjQCBA5twm3wicrHw== on 08/14/2019 Patterns in Forensic Decapitations A Review of the Literature and Case Report Marin A. Pilloud, PhD, D-ABFA,* Victoria M. Swenson, MA,* Rebecca L. George, MA,* and Laura D. Knight, MD†‡ Abstract: Separation of the head from the body can occur for a variety of reasons and in various locations across the neck. This study presents a review of the literature to identify the patterns of decapitations in forensic cases in relation to manner of death, age, and anatomical location (n = 88). The most common manner of death was suicide, followed by homicide and then acci- dent. Ages ranged from 32 weeks prenatal to 85 years. Decapitation is re- ported at higher rates for individuals between 19 and 65. The majority of decapitations occurred at the midneck (second to fifth cervical vertebrae), followed by the upper neck and then the lower neck. This pattern holds true for all manners of death; however, in homicides, the percentage occurring at the midneck decreases. The findings of this study indicate some patterns in terms of manner of death, age, and location of decapitation, which could aid the medicolegal community in interpreting neck trauma. A case study is also briefly presented to illustrate findings. Key Words: forensic anthropology, sharp force trauma, blunt force trauma, dismemberment, homicide, suicide (Am J Forensic Med Pathol 2019;40: 246–250) D ecapitation refers to the act of cutting, tearing, pulling, or other- wise removing the head from the trunk. The process of decapi- tation can result from (1) suicide, (2) homicide/dismemberment, (3) a traumatic accident, or (4) a judicial execution. Decapitation has been documented throughout many periods of human history across the globe to include the Neolithic, 1 Bronze Age, 2 Iron Age, 3 Middle Ages, 4 and during the prehistoric period in the New World 5,6 (see also Refs. 7 and 8 for further discussion). In a medico- legal context, it is possible to encounter remains where the head has been removed. In interpreting and documenting this trauma, it is helpful to have a working knowledge of common locations of decapitation and the soft tissue involved, as well as how these factors and age of the decedent are related to manner of death. There are currently no literature reviews that cover decapitations in this manner. This analysis rectifies this deficiency by providing a review of the literature to identify the common anatomical loca- tions of decapitations and explore relationships between location, age, and manner of death. A case study is presented to highlight the findings of this review. MATERIALS AND METHODS Literature for this study was reviewed from medical, forensic science, criminal justice, and anthropological journals and books. The search engine, OneSearch, available at the University of Nevada, Reno, and Google Scholar were used to identify available resources. This search covered nearly 170 years of published ma- terial and includes literature that provided any mention of decapi- tation. Sources focused on forensic contexts; bioarchaeological studies were not considered nor were cases of judicial execution by beheading. Once the sources were identified, data on age, cause of death, and location were collected. These variables were chosen for analysis because they influence how decapitations can occur and are commonly reported in the literature. Data on age of the decedents were divided into 6 categories: fetal to 5 years, 6 to 18 years, 19 to 34 years, 35 to 50 years, 51 to 65 years, and 66 years and older. Manners of death that were con- sidered include accident, homicide, and suicide. A category for other was also created for cases that did not fit those manners of death. Decapitation location was divided into 3 anatomical groups: (1) at the level of the base of the cranium to the superior margin of the second cervical vertebra (C2), (2) the inferior mar- gin of C2 to the inferior margin of the fifth cervical vertebra (C5), and (3) the superior margin of the sixth cervical vertebra (C6) to the inferior margin of the first thoracic vertebra (T1). RESULTS This review identified 188 cases of complete decapitation in the medicolegal literature. Of these cases, 88 clearly stated the manner of death, anatomical location of the decapitation, and/or age; only these cases are discussed here. 9–60 Of these 88 cases, the most common manner of death was suicide (n = 36/88, 40.9%), followed by accident (n = 26/88, 29.5%) and then homicide (n = 23/88, 26.1%), and 3 cases did not list manner of death (n = 3/88, 3.4%). The age range of indi- viduals in all of these cases was 32 weeks in utero to 85 years (mean, 38.7 years). The majority of cases (n = 62/88, 70.5%) oc- curred at the midneck, in the region of C2 to C5. The next most common location was in the superior neck to include separation at the cranium, atlas, or axis (n = 20/88, 22.7%). The least com- mon location was the lower neck, below the inferior margin of C5 (n = 6/88, 6.8%). Of those inferior to C5, 3 cases of decapita- tion were between the C6 and the seventh cervical vertebra (C7), and 3 cases were between C7 and T1. Age and manner of death were then considered (Fig. 1). Two case studies based on fetal decapitation were included. These in- volved a decapitation from a high-speed crash car crash resulting in complete decapitation and uterine rupture. 59 The other was ow- ing to a vacuum-assisted delivery. 21 These cases were included to explore differences in anatomy across various age cohorts. Decap- itation is much more common in the literature among individuals between 19 and 65, with suicide being the most common manner (n = 32/57, 56.1%). For younger individuals (<19 years), decapi- tation is most commonly the result of an accident (n = 3/6, 50%) or homicide (n = 2/6, 33.3%). Among older individuals (≥66 years), homicide is the most common manner of death in de- capitations (n = 2/4, 50%). Manuscript received January 4, 2019; accepted March 26, 2019. From the *Department of Anthropology, University of Nevada, Reno; †Washoe County Regional Medical Examiner's Office; and ‡Department of Pathology, School of Medicine, University of Nevada, Reno, NV. The authors report no conflict of interest. Reprints: Marin A. Pilloud, PhD, D-ABFA, University of Department of Anthropology, Nevada, Reno, 1664 N Virginia St, Reno, Nevada 89557. E-mail: mpilloud@unr.edu. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0195-7910/19/4003–0246 DOI: 10.1097/PAF.0000000000000490 CASE REPORT 246 www.amjforensicmedicine.com Am J Forensic Med Pathol • Volume 40, Number 3, September 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.