/What can a tiny bone tell us about Jeffrey Epsteins death?

What can a tiny bone tell us about Jeffrey Epsteins death?


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Jeffrey Epstein pleaded not guilty to charges of drug trafficking and allegedly sexually abusing dozens of underage girls in New York and Florida.
USA TODAY

The investigation into disgraced financier Jeffrey Epstein’s death could hinge on a minute bone in his neck that in the past has shed light on whether a cause of death is a suicide or a murder.

Epstein’s autopsy reportedly showed multiple broken neck bones, the Washington Post wrote Thursday, citing anonymous sources. But the curiosity surrounds one of the broken bones: The hyoid

Though the bone is small, it’s been critical in several high-profile cases. The reason: The hyoid can break when a person dies by hanging, particularly when a person is older. But it can also provide tell-tale clues that a person was strangled. 

Barbara Sampson, New York City’s chief medical examiner who is handling Epstein’s autopsy, said that the discovery of the broken hyoid doesn’t determine anything. The cause of the financier’s death is still pending.

“In all forensic investigations, all information must be synthesized to determine the cause and manner of death,” Sampson said in a statement to USA TODAY. “Everything must be consistent; no single finding can be evaluated in a vacuum.”

Epstein, 66, was found early Saturday in his cell at the Metropolitan Correctional Center in Manhattan. He had a bedsheet around his neck. According to the New York Post, he had tied the bedsheet to the bunk and leaned toward the floor to kill himself.

I’ve treated suicidal prisoners: Jeffrey Epstein’s death is a medical, security disgrace

What’s a hyoid?

The hyoid is a bone instrumental in tongue movement, swallowing, chewing and other functions. During respiration, the hyoid is what keeps the airway open.

In men, it’s located near the Adam’s apple. It anchors the larynx during vocal and respiratory movement, and its structure consists of a body and two pairs of horns, one larger and one smaller. 

The hyoid bone is not the Adam’s apple itself. The Adam’s apple is outwardly protruding thyroid cartilage surrounding the larynx. Instead, the hyoid is located just above the lump-like area.

The hyoid in murder cases:

This isn’t the first time the hyoid has been used to help determine a cause of death.

A fractured hyoid is present in approximately one-third of strangulation homicides, according to the National Center for Biotechnology Information.

A broken hyoid is often used in evidence to determine whether a victim was strangled:

  • A woman in Maine, Roxanne Jeskey, was found guilty in 2014 for killing her husband by strangling him, and the strangulation was proven by a broken hyoid
  • In 2011, Rebecca Zahau died in California. She reportedly was found hanging from a balcony in a beachside mansion. Years later, investigators looked to the hyoid bone to theorize whether she might have been a homicide victim.  
  • Earlier this year, in Georgia, a man, Shanard D. Rease, murdered an older woman by strangling her. Reports cited that her hyoid bone was fractured.

An unbroken hyoid is also occasionally cited as a reason to prove that an accused party is not guilty of strangulation. 

In a widely followed case in the New York City borough of Staten Island in 2014, Police Officer Daniel Pantaleo was accused with fatally choking Eric Garner. Pantaleo and other officers approached Garner, who they suspected was selling cigarettes without tax stamps. The officers attempted to arrest Garner and Pantaleo put him in a chokehold; Garner died after going into cardiac arrest.

But in a December 2018, release, the Police Benevolent Association said that their president, Patrick J. Lynch, called for charges against Pantaleo to be dropped since the hyoid was intact.

Garner “did not die of strangulation of the neck from a chokehold which would have caused a crushed larynx (windpipe) and a fractured hyoid bone,” said the release. 

Pantaleo was found guilty of using an improper choke-hold but not of intentionally restricting Garner’s breathing. 

Sampson, the chief medical examiner of New York City, oversaw Garner’s autopsy as well. She concluded that strangulation was the cause of Garner’s death.

Officer in Eric Garner’s death: Daniel Pantaleo, should be fired, NYPD judge says

The hyoid in death by suicide:

Guards found Epstein unconscious after he had been taken off of a prison suicide watch. His death was called an “apparent suicide” by federal authorities. 

Cyril Wecht, a forensic pathologist, told USA TODAY that he’s skeptical.

“Fractures of the hyoid bone are almost always associated with manual strangulation,” Wecht said. “Because a hand gets up high underneath the chin of the victim.”

Wecht said that multiple breaks or fractures in neck bones are rare to find in suicidal hangings. 

A fractured hyoid is possible from any blunt trauma to the neck. However, it is more common in a strangling than in a hanging, according to the National Center for Biotechnology Information

“Fractures of the hyoid bone in suicide hangings are rare and when you further keep in mind this was not a suicide hanging from stepping off a high ladder,” said Wecht.

According to reports, Epstein had tied a bed-sheet to the bunk and kneeled on the ground and then leaned forward to kill himself.

That maneuver, Wecht said, is not conducive to breaking bones.

“In majority of those you don’t see fractures because there is no great amount of force,” said Wecht. “It’s basic physics.”

Death would likely come from pressure applied to the neck and cut off circulation of nerves, particularly the vagus nerve, which is the tenth cranial nerve and longest nerve in the body, Wecht said.

Questions surrounding Epstein’s death, and any outstanding circumstances, such as his guards sleeping through checks, still fester.

And the bottom line, Wecht said, is that multiple fractures in suicide hangings are rare.

“This case right now has very strong odor to it,” said Wecht.

Follow Morgan Hines on Twitter: @MorganEmHines.

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