A rare case of ligature strangulation using a dental unit: Distinguishing suicide from homicide in a death scene investigation

Abstract Ligature strangulation is more common in homicides and is rarely seen in suicides and sexual asphyxia involving neck compression. We report a rare case of a dentist found dead of ligature strangulation next to a dental unit. The ligature was attached to the window frame, wrapped tightly around the neck once with a noose, and tied at the midpoint of the neck and at the head of the dental chair. A death scene and medicolegal investigation suggested suicidal ligature strangulation. The victim was squatting next to the dental unit with the control panel within reach. Pressing Button 1 (the recline button) would have tightened the ligature around the neck. A container containing pink nylon ribbon was found near the victim. The position of the knot at the front of the neck was consistent with suicide. Bloodstain pattern analysis confirmed the longitudinal flow pattern. No other remarkable findings were observed. Nobody had visited the clinic, autopsy found no drugs in his system, and the environment was undisturbed. Homicide was ruled out. According to witnesses, the victim had been in litigation with the owner of the building where his clinic was located. There were no reports of the victim having engaged in any unusual sexual or autoerotic activity. He had not received any death threats. Approximately 1 h before his death, he sent a suicide text message to his wife. Our case highlights the importance of distinguishing between suicide and homicide, especially in cases of ligature strangulation.