otg
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If she had been smothered with a hand, a pillow, or almost anything, there should be other trauma in and around her mouth which Dr. Meyer made a point to make note was NOT found (particularly the bolded):Some thoughts...
I've always thought an actual garrote was a cord wound once around the neck with handles on each end that were pulled to cut off airflow. I've been searching for "garrotes" and have seen talk of a cord being tied around the neck and pulled, often with a knee pushed onto the victims back to help with leverage. Would that be how this "strangulation device" (thanks Tawny for the term) was used?
Could she have been smothered with a hand and then the strangulation device be added afterwards? Hence that's how her hyoid bone not being broken.
The nostrils are both patent and contain a small amount of tan mucous material. The teeth are native and in good repair. The tongue is smooth, pink-tan and granular. No buccal mucosal trauma is seen. The frenulum is intact. There is slight drying artifact of the tip of the of tongue.
It is actually unlikely for the hyoid (or the cricoid) to be damaged in anything but manual strangulation -- even less so in children because it hasn't completely fused and ossified yet.