Atlas of Forensic Pathology

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CHAPTER 31 Special Dissections

not involve removal of the eye. If the eye itself is removed, this is done by identifying the eye globe invested in the orbital fat, and with gentle traction on the globe with forceps, pulling backwards and cutting the investing tissue, being cautious to not cut the upper or lower eyelids. After removal, the eye is fixed in formalin and then bisected for examination. Challenging to adequately photograph, the retina can be best illuminated either by directly shining a light source into the optic cup or by backlighting the eye with a light source, or both methods can be used.

DISSECTION OF VERTEBRAL ARTERIES WHEN PERFORMED

If a subarachnoid hemorrhage is identified and the source is not apparent (eg, trauma, a berry aneurysm, or arteriovenous malformation), that the source is a vertebral artery dis section or other anomaly should be considered. While the source for the vertebral artery lesion may reside intracranial, if an intracranial source for the hemorrhage is not identified, an extracranial source within the vertebral artery should be considered. HOW PERFORMED The vertebral artery can be examined through contrast injection and subsequent radiog raphy (Figure 31.3), or through direct dissection. 1 Exposure of the vertebral artery via dissection can be done through a posterior approach with removal of the bony canal sur rounding each artery.

DISSECTION OF THE ANTERIOR AND POSTERIOR NECK WHEN PERFORMED

A layer-by-layer dissection of the anterior neck is most often performed to evaluate asphyxial type deaths (eg, hanging, strangulation), or to assess for occult trauma in situations where the nature of the death is concerning for a strangulation or other form of inflicted injury (Figure 31.4). Given the ease with which an anterior neck dissection can be performed, some forensic pathologists may choose to do the dissection as a routine part of each autopsy. A pos terior neck dissection can be performed in similar situations, but is often performed when there

Figure 31.3. Radiography of the vertebral arteries. Although dis section of the vertebral arteries will allow for a gross visual inspec tion, injection of the vertebral arteries with contrast and subsequent radiography can also allow for examination of the vessels for poten tial pathology such as a dissection or ruptured aneurysm. Figure 31.4. Anterior neck dissection. The muscles of the neck are sequentially reflected to examine for hemorrhage. After removal of the neck organs, the pre-vertebral fascia and musculature should also be inspected for hemorrhage. If the neck organs are forced backward against the vertebral column, such as in a strangulation, hemorrhage in this location may result. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023