Dr. William R. Anderson, M.D.
Extensive skeletonization is noted with loss of most soft tissues associated with the skull, cervical spine, upper and lower extremities.
Examination of the skull reveals an intact cranium and cranial vault with no fractures identified, including the maxilla and dentition ofthe upper jaw.
A vertically oriented fracture is identified in the anterior aspect of the mandible, in the midline between lower incisors #24 & #25, with complete separation of the bone at this point. Blackish discoloration of the bone at this point is noted,
consistent with hemorrhage. The soft tissue in this area is absent secondary to post- mortem decomposition.
The teeth of the upper and lower jaws are intact. (Details per Odontological examination.)
No fractures are identified in the 1st and 2nd cervical vertebrae. Multiple bone fragments are noted corresponding to the 3rd cervical vertebra.
The examination ofthe skull following exhumation reveals a previously un- described prominent fracture of the mandible with evidence of hemorrhage, indicating an ante-mortem injury.
Review of radiological studies from the initial autopsy clearly demonstrates the fracture of the mandible, with partial displacement noted. Consistent with the findings, there are no other fractures evident in the x-rays of the skull.
Review of the photos from the initial autopsy reveals superficial lacerations with minimal associated mucosal contusion involving the labial commissures bilaterally, consistent with "stretching' ofthe skin secondary to expansile forces resulting from intra-oral discharge of a firearm.
Photos of the tongue removed during the initial autopsy show evidence of a close- range entry wound on the anterior aspect of the tongue near the tip, with a small amount of soot on the mucosal surface and slightly irregular margins.
The wound track extends in a front-to-back trajectory, exiting near the base of the tongue and continuing into the cervical spine area-associated with severe destruction of the C3 vertebral body and spinal cord.
Medical Examiner autopsy photos further indicate that the soft tissues immediately adjacent to the barrel of the gun-characterized by the presence of soot both at the entry wound margins and in the depth of the wound-and throughout the projectile track through the tongue, are intact.
The character of the gunshot projectile track further indicates that the tongue appears to have been in a retracted position atthe time of the shot-as demonstrated in the photos taken with the tissue forceps inserted in the tongue.
The presence and distribution of the soot indicates that the end of the muzzle was in close proximity and probable loose contact with the tongue when the weapon was discharged. This is the point at which the maximum amount of energy from blast effect would be released, and the maximum tissue damage to occur.
Clearly, there is no tissue destruction of the tongue aside from the actual bullet track, or injuries to the relatively thin bones of the maxilla and hard palate-the area most closely approximated to the point at which the blast effect would have occurred as the result of the intra-oral discharge of the firearm.
This indicates that while there was a degree of gas expansion within the oral cavity, documented by the expansion-type lacerations to the lips, there was insufficient energy to cause any damage to the soft tissues or boney structures in the vicinity.
Examination of the dentition shows no displacement of any teeth in either the upper or lower jaws. Since the teeth are anchored in the jaws by a ligamentous interface, the release of any significant energy force from an intraoral source could be expected to result in some displacement of those teeth.
In this case, however, there is the finding of a severe fracture to the anterior midline region of the mandible not associated with any injury to the dentition or mucosa
and soft tissues, even in the area immediately adjacent to the fracture itself.
The mandible is a thick, heavy, well-ossified bone, considerably larger and stronger than the facial bones, soft tissues of the oral cavity, tongue, and the dentition. And although we observe no significant blast-effect related changes in those tissues, a major fracture to the mandible, requiring a significant amount of blunt force to create, is clearly present.
In the evaluation of the entire injury pattern reveals that the blast effect, while present and confirming that this was an intra-oral discharge of a firearm, was not the mechanism by which the mandibular injury was incurred.
Since the maximum amount of energy being generated would be in the structures immediately adjacent to the end ofthe barrel-in this case well documented to be the tongue-any injuries resulting from that blast effect would have caused the most severe damage in that area.
Secondary injuries may also be present in such situations but are progressively less severe the further they are from the initial energy source-the expanding gasses from the gunshot muzzle blast.
In the case of Michelle O'Connell, the most severe injury, requiring the most energy to effect, is in the mandible, with sparing of the very structures most potentially vulnerable to injury, even though those soft and boney tissues are more proximate to the energy source.
Since the distribution of energy is linear, the 'sparing' of intermediate structures between the source and the fracture in the mandible, indicates that the latter was not the result of the firearm discharge.
The fracture of the mandible in this manner is most consistent with severe blunt force trauma from a source external to the oral cavity, and most likely represents a blow from either a fist or weapon. The amount of force required to produce this injury would have been significant and may well have incapacitated the victim.
From the scene photos, it is clear that she was face up with the distribution of blood from the mouth and nose, (a highly-vascular. area in which severe bleeding will occur immediately after a penetrating injury), indicates that Ms. O'Connell was on the floor face up when the gunshot wound was inflicted .
Consequently, the fracture in the mandible cannot be attributed to her falling after the wound. Indeed, the destruction of the cervical spinal cord would have prevented any purposeful movement after the gunshot wound was inflicted.
A second area of blunt force trauma is noted in the lateral aspect of the right peri- orbital soft tissues, where a small laceration with associated contusion is identified. Examination of the skull during the second autopsy indicated no significant boney injury to that area.
Examination of the photos from the initial autopsy reveals no.injury to either the soft tissues of the infra-lingual mucosa of the oropharynx, the upper lip, or cheek, thereby effectively eliminating the possibility that some mechanism of recoil of the weapon caused the mandible fracture.
Cause and Manner of Death:
In consideration of the injury patterns and forensic evidence available from the initial Medical Examiner evaluation and the findings of the second autopsy examination, the findings are most consistent of blunt force trauma causing incapacitation of Ms. O'Connell, and subsequent gunshot wound inflicted by another.
The manner of death should be considered Homicide.