Diagnostic issues in unusual asphyxial deaths

Upper airway occlusion may be due to a variety of causes and may result from accidents, suicides or homicides. Underlying natural diseases may also predispose to lethal choking episodes. A series of nine cases is reported to illustrate a range of circumstances that resulted in fatal upper airway compromise. These included suicide from upper airway obstruction due to an impacted blanket, and accidental deaths due to inhalation ofsoil, a rock, and a video cassette sticker. One death resulted from glottic obstruction due to a mucosal cavernous haemangioma, another from an enlarged tonsil, and two deaths were precipitated by underlying organic disease in the form of dementia and insulin-dependent diabetes mellitus. The manner of death was not clear cut in two cases where there was evidence of possible accidental death or suicide