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.

https://eu.usatoday.com/story/news/health/2019/08/15/mystery-surrounds-h...