Thyroid cartilage asymmetry as a potential diagnostic finding for occult cartilaginous fractures for the evaluation of nonfatal manual strangulation

Objective: This study is based on the hypothesis that occult cartilaginous fractures of the thyroid cartilage (TC) may result in asymmetry of the thyroid cartilage framework. Justification of this hypothesis was provided by an estimation of the prevalence of TC asymmetry based on a consecutive postmortem study group. The findings were then compared to three cases of nonfatal manual strangulation and one case of survival of blunt trauma to the neck. Methodology: TC images from a consecutive two-year sample from the institutional postmortem computed tomography database (N= 1187) were assessed. Cases with acute TC injury were excluded. TC asymmetry, signs of prior TC trauma, sex and age, were retrieved. Results: TC asymmetry was present in 72 cases (6.2%, 67 males). In 40 cases (3.5%), old TC fractures could be identified. The derived odds ratios were 7.48 for male sex and 1.02 for (each year of) age (p <0.001). Asymmetry of the TC laminae was observed significantly more often on the left side (N= 53, 73.6%, p <0.001). Cases 1 and 2 showed TC asymmetries following nonfatal manual strangulation. Cases 3 and 4 illustrated the limited visibility of cartilaginous fractures on computed tomography. Conclusion: TC asymmetry is associated with male sex and older age and is typically located on the left side. TC asymmetry in young and female cases is rare. TC asymmetry in young and/or female cases may result from occult cartilaginous fractures, as cases 1 and 2 indicated. Further research is needed to validate this hypothesis.