Occipitoatlantal dislocation is usually seen as a fatal injury in traffic accidents and has rarely been reported as a consequence of a homicide. The authors report the case of a woman presenting a fatal occipitoatlantal dislocation, the circumstances of which pointed to a homicidal origin. Blood extravasation surrounding the muscles of the posterior part of the neck as well as abnormal mobility of the cranio-cervical joint was noted during autopsy; thus a complete dissection of this region was performed. This led to the finding of a fracture of the left occipital condyle and of the left superior articular facet of the atlas. This case clearly demonstrates the need to perform a large, systematic, posterior approach to the upper cervical spine, completed by the opening of the skull around the posterior fossa, when injury to the cranio-cervical junction is suspected. In these cases, the classic anterior approach gives poor information and poor dissection possibilities.
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