Godin A, Kremer C, Sauvageau A.
Am J Forensic Med Pathol. 2012 Mar;33(1):4-7.

Abstract
The distinction of a suicidal hanging from a simulated hanging following a homicidal strangulation is highly challenging. The present study evaluates the fracture of the cricoid cartilage as a potential pointer toward homicide. Despite the numerous studies on neck structures fractures in hanging, this is the first study to concentrate on the cricoid cartilage. Neck structures fractures in all cases of suicidal hanging over a 6-year period were retrospectively reviewed (231 cases) and a comparison with homicidal hangings (4 cases) and homicidal no-hanging strangulations cases (52 cases) was performed. Overall, neck structures fractures were found in 23.4% of suicidal cases (54 cases). The cricoid cartilage was intact in all suicidal hangings. The general incidence of fractures in homicidal no-hanging strangulation was 65.4% (34 cases),with an incidence of fracture of the cricoid cartilage of 20.6%. By compiling studies from the literature, only one cricoid cartilage over 2700 suidical hanging cases was found, whereas an incidence of 5 to 20% is found for homicidal strangulation. It is therefore proposed that the presence of a fracture of the cricoid in an apparent suicidal hanging should be considered highly suspicious.