54 Med. Sci. & L. 1 (2014)

handle is hein.journals/mdsclw54 and id is 1 raw text is: 



Review article


Laryngeal anomalies: Pitfalls in adult

forensic autopsies


Medicine, Science and the Low
2014, Vol 54(1) 1-7
@ The Author(s) 2013
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DOI: 10. 1177/0025802413485731
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AS   Advenier', G Lorin De La Grandmaison', S Cavard',
N  Pyatigorskaya2, D Malicier3 and P Charlier'




Abstract
Objective: This is the first paper to group together most of adult laryngeal anomalies or malformations which may be
misinterpreted by the forensic pathologist and taken for a proof of violence.
Material  and methods:   A review of the literature, to list the main pitfalls, to explain their nature and their origins.
Results: We  found two main categories, the congenital defects and the acquired anomalies.
Conclusions:  The laryngeal region is complex. The pathologist must keep in mind anatomical variations or malforma-
tions, but also sequelae of old injuries and iatrogenic lesions. The survey, the patient's clinical history, the findings of the
whole autopsy and, if necessary, histology may help to interpret a laryngeal anomaly.


Keywords
adult, laryngeal anomalies, pitfalls, forensic autopsy, congenital defects, acquired anomalies


Introduction
In adult forensic pathology, the laryngeal complex has
a great importance  and must  be carefully examined,
especially when  a homicide  is suspected. However,
there are pitfalls that may induce false interpretations.
Most  of the laryngeal peculiarities have been the sub-
ject of a paper. They have been described in different
reviews, generally for specialists. But as they are rare,
they are little-known. As a result, when confronted
with one of these peculiarities, the forensic pathologist
can make  a wrong  and serious interpretation. In this
paper, we present a review of the literature concerning
the main pitfalls which must be known by the forensic
pathologists and  which  are here grouped  together.
The  congenital defects and  the acquired anomalies
are  discussed. To  finish, rare causes of asphyxial
deaths are mentioned.


Review of the literature
Pseudo-traumatic  lesions and pseudo-contusions can
be divided in two groups: congenital and acquired.
   Birth defects are examined first.
   Beyond   them, Eagle  syndrome   is a rare entity
characterized by an elongated and ossified styloid pro-
cess (Figure 1), responsible for clinical signs due to
compression  of the vasculonervous structures of vicin-
ity. Eagle syndrome  can occur  unilaterally or bilat-
erally and  most frequently results in symptoms   of
dysphagia,  headache, pain on  rotation of the neck,


pain  on extension of  the tongue, change  in voice,
and   a sensation  of  hypersalivation.1 Neurologic
exam  is normal. Although  approximately  4%  of the
population  is thought to have an  elongated styloid
process, only a small percentage  (between  4%  and
10.3%)  of this group is thought to be actually symp-
tomatic. Diagnosis is made both by physical and radi-
ological examination.  The   normal  length  of  the
styloid  in  an   adult  is  approximately   2.5 cm.
Consequently,  this process is not normally palpable.
Its palpation in the tonsillar fossa is indicative of elon-
gated styloid, generally >3 cm in length, and generally
exacerbates  symptoms.   Radiology   and  computed
tomography   show  an elongated ossified styloid pro-
cess, with one side larger than the other.2 The thick
calcified process extend from the  stylomastoid for-
amen  to the hyoid  bone. However,  the presence  of
an  elongated styloid process is not pathognomonic
for Eagle syndrome  because many  patients with inci-
dental findings of an elongated  styloid process are
asymptomatic.  The  pathophysiological  mechanisms


'Department of Pathology and Forensic Medicine, Paris-Ouest
University, AP-HP/UVSQ, Raymond Poincare Hospital, Garches, France
2Department of Radiodiagnostic, Paris-Ouest University, AP-HP/
UVSQ, Raymond Poincare Hospital, Garches, France
3Forensic Institute, Lyon I University, Lyon, France

Corresponding author:
Anne-Sophie Advenier, Department of Forensic Institute, Lyon I
University, 12, Avenue Rockefeller, 69008 Lyon, France.
Email: annesophieadvenier@ymail.com

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