Suicidal hanging may occur with or without marks on the neck. e presence of a groove or furrow on the neck can suggest the type of noose or loop used. Horizontal skin folds and creases on the neck of obese persons or infants may resemble a noose mark. Genuine noose marks remain a¤er the bloating and skin slippage of decomposition. Over 50% of suicidal hangings show petechial congestion hemorrhages on the face and neck above the level of the noose. ese may also be present in the mouth and conjunctiva (see Chapter 12, Figure 12.1). Injury to the strap muscles is rare in hanging, and fracture of the thyroid cartilage or hyoid bone is the exception rather than the rule. e victim may have nail marks and bruises on the neck and —ngers secondary to a reŒex action to preserve life (Spitz et al. 2006).