An autopsy found that financier Jeffrey Epstein sustained multiple breaks in his neck bones, according to two people familiar with the findings, deepening the mystery about the circumstances around his death.
Among the bones broken in Epstein’s neck was the hyoid bone, which in men is near the Adam’s apple. Such breaks can occur in those who hang themselves, particularly if they are older, according to forensics experts and studies on the subject. But they are more common in victims of homicide by strangulation, the experts said.
The office of New York City’s chief medical examiner, Barbara Sampson, completed an autopsy of Epstein’s body Sunday. But Sampson listed the cause of his death as pending.
Asked about the neck injuries, Sampson said in a statement that no single factor in an autopsy can alone provide a conclusive answer about what happened.
People familiar with the autopsy, who spoke on the condition of anonymity due to the sensitive stage of the investigation, said Sampson’s office is seeking additional information on Epstein’s condition in the hours before his death. That could include video evidence of the jail hallways, which may establish whether anyone entered Epstein’s cell during the night he died; results of a toxicology screening to determine if there was any unusual substance in his body; and interviews with guards and inmates who were near his cell.
Jonathan L. Arden, president of the National Association of Medical Examiners, said a hyoid can be broken in many circumstances but is more commonly associated with homicidal strangulation than suicidal hanging.
Arden, who was not involved in the Epstein autopsy, said that in general, a finding of a broken hyoid requires pathologists to conduct more extensive investigation. That investigation can include analysis of the location of the noose, how narrow the noose is, and if the body experienced any substantial drop in the course of the hanging.
The age of the deceased is also important, Arden said. The hyoid starts out as three small bones with joint-like connections but hardens during middle age into a U-shape that can break more easily.
“If, hypothetically, the hyoid bone is broken, that would generally raise questions about strangulation, but it is not definitive and does not exclude suicidal hanging,” he said.
A handful of studies conducted over the past decade have produced conflicting results about the likelihood of a hyoid break in a suicide. In a study of 20 suicidal hangings in Thailand, published in 2010, one-fourth of the men who hanged themselves had broken hyoids. In a larger study of suicidal hangings of young adults and middle-aged people in India, conducted from 2010 to 2013, hyoid damage was found in just 16 of 264 cases, or 6 percent. The study addressed the discrepancies in academic reviews, saying wide variations in findings of hyoid breaks are “possibly due to factors like age of the victim, weight of the victim, type of suspension and height of suspension.”
Hyoid fractures have previously sparked controversy in jailhouse and other contentious deaths.
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