Warning: This story discusses suicide
Bruises on Pauline Hanna's arm could show she was grabbed and held before she died.
The murder trial of former eye surgeon Philip Polkinghorne is continuing at the High Court at Auckland.
Polkinghorne is accused of killing Hanna, his wife, and staging her death to look like a suicide.
Dr Kilak Kesha was called to the witness box on Tuesday morning to outline the post-mortem he performed on Hanna.
"Before the post-mortem starts, we do a complete body CT scan, then we start with an external examination," he said.
"After that's completed, I do an internal examination where I systematically dissect every organ."
During the external examination, Kesha noted marks on Hanna's eyelids and face.
"[There were] small pinpoint red contusions or haemorrhages," he said.
"We commonly see them when there's an obstruction to the neck veins, when you occlude these superficial veins the blood continues to go to the head, but it can't come back, [which causes ruptures]."
He also noted that Hanna's tongue was protruding past her teeth.
"We commonly see protruding tongues during hangings," he said.
"When there's a hanging the larynx is pushed up and back, forcing the tongue to come forward."
Hanna also had scrapes and marks on her nose and right arm.
"You can see on the bridge of her nose some discoloration or markings, and on the left side of the nose you can see some discoloration," he said.
"There's a lot of reasons [that can happen], she may have fallen and hit her nose, or someone may have struck her nose."
On her arm, bruises indicated she may have been grabbed.
"We see [bruises like these] quite often if someone is held and those are the finger marks on the arm," he said.
"You're not saying they are, but they could be?" Crown prosecutor Brian Dickey asked.
"That's correct," Kesha replied.
Kesha explained the bruises had not yellowed at the time of his examination. He said yellowing typically occurred after three days.
Polkinghorne's lawyer, Ron Mansfield KC, asked Dr Kesha if Hanna's injuries could have originated from suicide.
"Would I be right to say your findings are consistent with suicide by hanging?" Mansfield asked.
"No, it's consistent with several different mechanisms," Kesha clarified.
"Is one of the mechanisms suicide by hanging?" Mansfield continued.
"Yes."
Mansfield then pressed Kesha on where the bruises on Hanna's arm could have originated.
"So, for example, if someone needed to be steadied if they were at the gym and someone took hold of their arm, that could have caused some of those bruises," he said.
"Or if she was climbing on an ottoman to reach the upper cupboard to get some soft toys and someone had to brace her as she got down, that might also explain it?"
"Yes," Kesha replied.
"So what we do know is none of those injuries can be connected with her death," Mansfield confirmed.
But Kesha also noted that the marks on Hanna's neck were not typical of a hanging.
"There's a ligature mark on the neck; it's going directly back and horizontal," he said.
"With a hanging, the point of suspension is above the head, so the marking you would expect to go backwards and upwards, [but] again if you look at this photo it's going directly back, which is more consistent with a ligature strangulation."
Mansfield then pressed Kesha on why that detail was not included in his autopsy report.
"Why is it today for the first time you're telling us that the position of the belt impression might have some significance?" he asked.
"I've told the police from day one," Kesha replied.
"Well, where is it within your report?" Mansfield continued.
"You then prepared a formal written statement for your hearing. Is there any mention in this report, doctor, of your apparent observation?"
"No," Kesha said, "I wasn't asked."
"Well, it's not a matter of being asked. You're the expert, are you not? If this was of significance, why did you not refer to it?" Mansfield asked.
"Well, I didn't refer to toxicology, and I thought that was relevant too," Kesha said.
Dr Kesha also said the strap muscles in Hanna's neck were relatively undamaged - an unlikely occurrence if someone had been strangled by hand.
"In this case, there was no reported strap muscle haemorrhage?" Mansfield asked.
"That is correct," Kesha replied.
"You don't expect to get strap muscle haemorrhage in a suicide by hanging, do you?"
"It's not common, no."
The trial continues.
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