Rom J Leg Med [21] 169-172 [2013] DOI: 10.4323/rjlm.2013.169 © 2013 Romanian Society of Legal Medicine 169 Possible death mechanisms other than respiratory asphyxia in a suicidal hanging case Murat Nihat Arslan * , Deniz Oguzhan Melez, Hatice Gulbeyaz, Bilgin Hosukler, Bulent Sam, Sermet Koc _________________________________________________________________________________________ Abstract: Hanging is the most common suicide method that has seen in the routine autopsy practice. Known mechanisms of death include asphyxiation due to airway obstruction, cerebral ischemia due to arterial blockage, vagal inhibition (reflex cardiac arrest) due to carotid sinus compression, congestion due to venous blockage, fractures in cervical vertebral column with the cord injury. A 84 year-old man with totally laryngectomy found hanging from a tree in the garden of his house, and referred to Council of Forensic Medicine to determine cause of death. On the autopsy upper airway found to be ligatured from the level of hypopharynx. Case has been breathing via laryngectomy hole on his neck before suicide attempt. Case has been determined to be an interesting example for mechanism of death other than respiratory asphyxia in hanging cases. Key Words: hanging, totally laryngectomy, mechanism of death. *)Council of Forensic Medicine of Turkey * Corresponding author: MD, Adli Tip Kurumu Baskanligi, Cobancesme mah, Kimiz sok, No.1, 34196 Bahcelievler, Istanbul, Turkey, E-mail :mnarslan@yahoo.com H anging is the most common suicide method that has seen in the routine autopsy practice [1]. According to Turkish statistical suicide data from Turkish Statistics Institute between the years 2002-2011 hanging was the most common suicide method for both sexes [2]. In hanging cases there are various mechanisms that lead to die. Known mechanism include asphyxiation due to airway obstruction, cerebral ischemia due to arterial blockage, vagal inhibition (reflex cardiac arrest) due to carotid sinus compression, congestion due to venous blockage, fractures in cervical vertebral column with the cord injury [3-6]. We present a suicidal hanging case with totally laryngectomy. This case was interesting about some couple of issues. There are some interesting topics to be discussed on this case. First, the mechanism of death, other than mechanical asphyxiation. Second, again the mechanism of death but from other point of view which is difficult to be known by people out of medicine practice (especially forensic medicine) and its criminal aspect. Third, may be the will to die in a case with cancer. CASE A 84 year-old man found hanging from a tree in the garden of his house. On the information which was obtained from his wife, it was learned that he was suffering and having treatment for larynx cancer for 2 years. He had a totally laryngectomy operation 2 years ago. There were no struggle findings on the death scene or at home; there was a chair which was thought to be used for jumping from the height to complete the hanging. After initial inspections case was referred to our Morgue Department to determine the cause of death. A laryngectomy hole was seen on the external examination