Mechanical Asphyxia in Forensic Medicine: Pathophysiology, Diagnosis, and Modern Trends
Downloads
Mechanical asphyxia is one of the most critical forms of hypoxic injury, playing a significant role in both clinical and forensic medicine. This article explores the main subtypes of mechanical asphyxia-hanging, positional, compressive, and autoerotic—and analyzes their distinct pathophysiological mechanisms. Special attention is paid to strangulatory trauma, upper cervical spine fractures, and their role in the genesis of death. The forensic importance of identifying antemortem injuries is emphasized. Modern diagnostic technologies, such as 3D photogrammetry, virtual autopsy, and biochemical markers, are discussed as emerging standards in forensic investigation, offering improved precision and reliability in classifying asphyxial deaths. The review integrates current international literature and forensic data from Georgia, aiming to bridge scientific and practical approaches to asphyxial injury evaluation.
Downloads
ბესარიონ კილასონია ,,სასამართლო მედიცინა“ თბილისი 2011;
თეიმურაზ გორდელაძე ,,სასამართლო მედიცინა“ თბილისი 2008;
Bitadze, L., & Elguja, L. (2022). Frequency and Types of Traumas in Khevsureti according tothe Fossil Material of the High and Late Middle Ages. https://openscience.ge/entities/publication/edeae3c1-8669-4f8c-bfd6-4bd01c064215 https://doi.org/10.48616/openscience-60;
Latchkepiani, E., Gambarashvili, M., & Kochadze, D. (2024). Heart rupture – a complication of adrenal cortical adenoma – case report. Georgian Scientists, 6(2), 405–416. https://doi.org/10.52340/gs.2024.06.02.42;
Byard, R. W. (2021). Positional asphyxia: A forensic pathologist’s perspective. Forensic Science, Medicine and Pathology, 17, 185–191. https://doi.org/10.1007/s12024-020-00324-3;
Kroll, M. W., et al. (2017). Physiological and practical aspects of positional asphyxia: A review and discussion of the literature. Journal of Forensic and Legal Medicine, 52, 35–42. https://doi.org/10.1016/j.jflm.2017.08.005;
DiMaio, V. J., & DiMaio, D. (2001). Forensic Pathology (2nd ed.). CRC Press;
Sauvageau, A., & Boghossian, E. (2010). Classification of asphyxia: The need for standardization. Journal of Forensic Sciences, 55(5), 1259–1267. https://doi.org/10.1111/j.1556-4029.2010.01447;
Davis, G. G. (1997). Deaths in police custody. American Journal of Forensic Medicine and Pathology, 18(1), 1–6. https://doi.org/10.1097/00000433-199703000-00001;
Taff, M. L. (1996). Positional asphyxia. American Journal of Forensic Medicine and Pathology, 17(4), 299–302. https://doi.org/10.1097/00000433-199612000-00002;
Karger, B. (2002). Asphyxia: Physiology and forensic pathology. Forensic Science International, 128(3), 185–187. https://doi.org/10.1016/S0379-0738(02)00188-6;
Schmidt, P. & Madea, B. (2015). Asphyxia deaths related to restraint and positional asphyxia. In: Encyclopedia of Forensic and Legal Medicine (2nd ed.). Elsevier. https://doi.org/10.1016/B978-0-12-800034-2.00128-3;
Shkrum, M. J., & Ramsay, D. A. (2007). Forensic Pathology of Trauma: Common Problems for the Pathologist. Humana Press;
Pollanen, M. S., et al. (1998). Unexpected death related to restraint for excited delirium: A retrospective study of deaths in police custody in Ontario. Canadian Medical Association Journal, 158(12), 1603–1607;
Kochadze, D., Latchkepiani, E., & Makharashvili, R. (2025). "Traditional Georgian Ethnopharmacology: Historical Foundations, Medicinal Plant Cultivation Practices, and Knowledge Transmission Pathways". Georgian Scientists, 7(2), 730–744. https://doi.org/10.52340/gs.2025.07.02.69;
Levine, A. M., & Edwards, C. C. (1985). The management of traumatic spondylolisthesis of the axis. The Journal of Bone and Joint Surgery. American Volume, 67(2), 217–226. https://doi.org/10.2106/00004623-198567020-00010;
Wetzel, F. T., & La Rocca, H. (1989). Hangman's fracture: a clinical and radiographic review. Spine, 14(9), 917–923. https://doi.org/10.1097/00007632-198909000-00010;
Demetriades, D., et al. (2000). Cervical spine injuries: early predictors of poor outcome. The Journal of Trauma, 48(5), 729–734. https://doi.org/10.1097/00005373-200005000-00001;
Risse, M., & Krähn, T. (2020). Post-mortem radiology of hangman’s fracture: forensic implications. International Journal of Legal Medicine, 134(6), 2067–2072. https://doi.org/10.1007/s00414-020-02347-z;
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596;
Steinberg A. Prone restraint cardiac arrest: A comprehensive review of the scientific literature and an explanation of the physiology. Medicine, Science and the Law. 2021;61(3):215-226. doi:10.1177/0025802420988370;
World Health Organization. (2023). International Classification of Diseases, 11th Revision (ICD-11). https://icd.who.int/;
Sauvageau, A. (2006). Autoerotic asphyxiation: A comprehensive review of the literature. The American Journal of Forensic Medicine and Pathology, 27(2), 134–139. https://doi.org/10.1097/01.paf.0000210601.25273.8e;
Byard, R. W. (2021). Forensic issues in cases of autoerotic asphyxia. Forensic Science, Medicine and Pathology, 17(2), 281–287. https://doi.org/10.1007/s12024-021-00348-0;
Hucker, S. J. (2019). The role of forensic psychiatry in the assessment of autoerotic fatalities. Journal of the American Academy of Psychiatry and the Law, 47(3), 310–318. https://doi.org/10.29158/JAAPL.003857-19;
Shields, L. B. E., & Hunsaker, J. C. (2016). Autoerotic fatalities: A 10-year retrospective study. Journal of Forensic Sciences, 61(4), 1038–1044. https://doi.org/10.1111/1556-4029.13092;
Kerns, T. J., & Kraus, J. F. (1994). Deaths due to autoerotic asphyxiation in Los Angeles County: An update and review. Journal of Forensic Sciences, 39(6), 1435–1441. https://doi.org/10.1520/JFS13689J;
Wilson, C. L., Vance, J. E., & Sloan, T. B. (2015). Hypoxia-induced neurochemical changes and MRI spectroscopy. Neurocritical Care, 23(2), 236–245. https://doi.org/10.1007/s12028-015-0118-6;
Hucker, S. J., & Bain, J. (1990). Asphyxiophilia and autoerotic deaths: A review. Canadian Journal of Psychiatry, 35(6), 542–548. https://doi.org/10.1177/070674379003500610;
Geddes, L. A., & Roeder, R. A. (2003). Criteria for death in autoerotic asphyxiation. Forensic Science International, 134(2–3), 142–146. https://doi.org/10.1016/S0379-0738(03)00143-4;
Smith, M. A., & Freeman, M. D. (2020). Photogrammetry in forensic pathology: modeling ligature marks for digital analysis. Journal of Forensic Sciences, 65(6), 2018–2026. https://doi.org/10.1111/1556-4029.14556;
Byard, R. W. (2021). Forensic implications of vitality markers in ligature strangulation. Forensic Science, Medicine and Pathology, 17(3), 400–407. https://doi.org/10.1007/s12024-021-00350-1;
De-Giorgio, F., et al. (2019). Immunohistochemical assessment of inflammation and hypoxia markers in mechanical asphyxia. Legal Medicine, 36, 45–51. https://doi.org/10.1016/j.legalmed.2018.11.006;
Kühn, H., & Thali, M. J. (2023). Advances in virtual autopsy and forensic imaging: reconstructing the truth beneath the surface. Forensic Imaging, 5, 100053. https://doi.org/10.1016/j.fri.2022.100053;
De-Giorgio, F., Lodise, M., Borriello, R., & Sessa, F. (2019). HIF-1α and IL-6 as potential markers of vitality in forensic pathology: A systematic review. Journal of Forensic and Legal Medicine, 65, 101–106. https://doi.org/10.1016/j.jflm.2019.05.004;
Ehrlich, L., Ross, S. G., & Rogers, C. (2022). Application of 3D surface scanning for forensic analysis of patterned injuries in neck compression. Journal of Forensic Sciences, 67(5), 1965–1973. https://doi.org/10.1111/1556-4029.15003;
Michael J, M.D Thail, Michael Rhail, Richard Dirnhofer, Peter Vock - The Virtopsy approach: 3D Optical and Radiological Scanning and Reconstruction in Forensic Medicine 2012;
Joseph A. Prahlow and Roger W. Byard - Atlas of Forensic Pathology London 2012.
Copyright (c) 2025 Georgian Scientists
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
