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Had Jeffrey Epstein been only twice as old as his teenage victims, his hyoid bone would have remained so flexible that a fracture would have been a much stronger indication he had been strangled.
But at 66, the U-shaped bone between his chin and his Adam’s apple likely would have become so brittle with age that it also could have been broken by hanging.
That would include a suicide effort involving no more force than could be generated kneeling down with a noose around your neck until you become unconscious.
“Your own body weight completes the job,” a forensic pathologist of long experience who asked not to be quoted by name told The Daily Beast on Thursday.
A hyoid bone fracture would not likely have been caused by resuscitation efforts.
“That would be extremely unusual,” the pathologist said. “I’ve never seen that.”
Examination of the hyoid bone is standard procedure at autopsy. Signs of hemorrhaging as the surrounding neck muscle is cut away alert the forensic pathologist to the possibility of a fracture. The hyoid is relatively easy to remove, but considerable care is customarily taken lest anybody suggest that extraction was the source of any damage.
A through-and-through break is generally easy to see. Lesser fractures also are usually detectable by visual examination, the pathologist said.
But while hyoid breaks of whatever size are more common in strangling than in hanging, examination of the bone is not in itself likely to determine which was the cause of death.
One possible determining factor is the location of the ligature. The discovery of the body likely triggers such a panicked rush to remove the noose that nobody is able to recall exactly where it was. The medical examiner must then seek an answer in marks on the skin of the neck.
A noose fashioned from a sheet or a blanket would likely leave less vivid marks than from a rope or even less so from a wire. The vividness would increase with the length of time before the body was discovered.
Marks that indicate the noose was below the hyoid bone would suggest that the hanging was staged and the actual cause of death was strangulation. Marks in the area between the chin and Adam’s apple would indicate the death was more likely a hanging.
Suicidal hanging behind bars is most common from a kneeling or sitting position, with the other end attached to something as low level as a bedpost or a doorknob. The pathologist who spoke to The Daily Beast recalled he had a particular problem with family members in such cases.
“Nobody believed me,” he said.
In the case of Epstein, his cell in the Special Housing Unit (SHU) at the Metropolitan Correctional Center (MCC) may not have been checked for three hours. Regulations require officers in the SHU to check each prisoner every 30 minutes.
Some theorists suggest this lapse and the broken hyoid bone point to a murder conspiracy. A former prisoner who was briefly held in the SHU back in 2016 recalls a similar interval between checks.
“They did every three or four hours,” Taras Petro Nykoriak told The Daily Beast this week.
Nykoriak recalled that the checks themselves involved only the time it took for the officer to peer through the small window in the cell door.
“Pause and count and keep going,” he recalled. “They usually don’t talk to the inmate.”
Imagine the panic the officer felt when he finally did make a check and saw Epstein in the classic pose of a jail suicide.
As of Thursday night, New York City Chief Medical Examiner Barbara Solomon had not announced the cause of death. Investigators were still seeking to establish exactly what happened.
The removed hyoid bone sits in preservative fluid, the break proving—if nothing else—the age of the monster who preyed on young girls