Atlas of Forensic Pathology

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ATLAS OF FORENSIC PATHOLOGY

is a concern for occult trauma of the neck (eg, a decedent found after a motor vehicle accident with the remainder of the autopsy revealing no lethal traumatic injuries) (Figure 31.5). HOW PERFORMED With a layer-by-layer dissection of the anterior neck, each of the anterior neck muscles is sequentially reflected. One way to proceed is the sternocleidomastoid muscles, followed by the omohyoid muscles, followed by the sternohyoid muscles, followed by the sternothyroid muscles. After removal of the neck organs, the pre-vertebral fascia and pre-vertebral mus culature should be inspected for hemorrhage. With a posterior neck dissection, the muscle layers are not as clearly defined; however, the muscles are reflected to assess for hemorrhage and to expose the spinous processes of the cervical vertebrae. The laminae are cut and the posterior portion of the cervical vertebrae is removed, revealing the spinal cord. Following removal of the spinal cord, the integrity of the atlanto-axial joint and alar ligaments can be directly inspected. Dolinak and Matshes neuropathology atlas has a good description of the procedure and demonstrative images. 2 DISSECTION OF THE CERVICAL VERTEBRAL COLUMN WHEN PERFORMED The cervical segment of the vertebral column is examined in the investigation of suspicious infant deaths to allow for examination of the spinal nerves and dorsal root ganglia. HOW PERFORMED The cervical segment of the vertebral column can either be entirely removed or the dor sal root ganglia and spinal nerves can be examined in situ by removing the surrounding bone. 3,4 If the cervical segment of the vertebral column is removed in its entirety, it is a good idea to fix the entire segment prior to examination. Following the fixation, the segment of cervical vertebral column should be decalcified and can then be serially sectioned to inspect the spinal nerves and dorsal root ganglia.

EXAMINATION FOR PNEUMOTHORAX WHEN PERFORMED

A pneumothorax commonly occurs secondary to trauma; however, a spontaneous pneu mothorax can also occur secondary to a natural disease process such as the rupture of an emphysematous bleb.

Figure 31.5. Posterior neck dissection. Although the posterior neck muscles are not as easily dissected in a layer-by-layer approach like the muscles in the anterior neck, they can be examined for hemor rhage, and the spinal cord can be exposed via a posterior approach. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023