External neck compression: A review of forensic literature with an illustrative case

Fatal external neck compression represents a well-recognized but diagnostically challenging form of mechanical asphyxia, particularly when external signs are absent or minimal. In occupational settings, such deaths may be misclassified if the mechanism of injury is not fully understood through death scene investigation. We report a fatal workplace accident involving a 51-year-old bakery worker whose neck became entrapped between rigid metal bars of a hydraulic filling machine during an operational malfunction. Despite marked facial cyanosis and petechiae, no visible external neck injuries were present. The diagnosis of mechanical asphyxia was established through the integration of death scene reconstruction and internal autopsy findings, which revealed extensive unilateral hemorrhages of the cervical soft tissues, vascular bundle, and peri-thyroid structures, consistent with localized traumatic compression. To contextualize this case, a focused review of the forensic literature published between 2000 and 2023 was conducted, identifying comparable cases of fatal external neck compression from accidental mechanical sources. The review highlights that external neck findings are frequently absent or non-specific, whereas internal injuries and scene analysis often provide the decisive diagnostic elements. This report emphasizes the risk of under-recognition of external neck compression in occupational fatalities and underscores the critical role of meticulous death scene investigation combined with targeted internal examination in establishing the correct cause and manner of death. The case provides a practical diagnostic message for forensic pathologists confronted with externally subtle but internally severe asphyxial deaths.