Forensic physician’s dilemma: Attempted suicide or homicide? A case report of an atypical cut-throat injury

Abstract

Cut-throat injuries are among the most serious forms of sharp force trauma encountered in medico-legal practice and frequently present complex interpretative challenge as they may suggest suicide, homicide or rarely, be accidental. particularly when classical morphological features are absent. In this case a 48-year-old woman with a history of depressive disorder presented with a deep transverse incised wound to the anterior neck, requiring emergency tracheostomy and surgical repair. Operative findings revealed two full-thickness incisions involving the thyroid cartilage and thyrohyoid membrane, with sparing of major cervical vessels. The wound margins were irregular with no hesitation cuts or tailing observed. No defence injuries were identified. The victim was found inside a locked washroom and a paper cutter knife was discovered nearby. Forensic psychiatric evaluation revealed active suicidal ideation. Despite the atypical wound morphology, the collective clinical, circumstantial and psychiatric findings supported a self-inflicted injury. This case highlights the importance of holistic medico-legal analysis and cautions against reliance on morphology alone in determining manner.