One hundred eighty-nine cases of known dead bodies brought for medicolegal autopsy with alleged history of hanging were studied at the Department of Forensic Medicine, State Medico Legal Institute, Government Medical College, Thiruvananthapuram, Kerala, India. All the findings noticed during detailed external examination and flap dissection of the neck were analyzed with special emphasis on correlation between the external and internal injuries on neck.There was a preponderance of males in the study group (70.9%), majority of them being middle-aged (64.9%). Among females, the major group was composed of adolescents and young adults (72.8%). Easily available materials were used as ligature materials. Soft materials such as saree, shawl, lungie, and so on were used as ligature by 47% of victims and hard materials such as coir rope, plastic rope, telephone cable, and so on were used by 29% of victims. Oblique ligature mark was noted in 94.2% of cases. The ligature mark was noncontinuous in 78% of cases. Horizontal ligature marks were noted in cases of partial hanging.Rupture of muscle fibers at the lower attachment of sternomastoid was seen in 19.6%, and carotid intimal tear was seen in 1.1% of cases. Fracture of hyoid bone at their greater horns was seen in 2.7% and thyroid cartilage in 5.3% of cases. Vertebral fracture and dislocation were noted between third and fourth cervical vertebrae in 1.6% of cases. Neck skeleton injuries were noted in persons older than 38 years.