The hyoid fracture will be the key to this, if the hyoid is fractured the examining pathologist will expand the examination, since most hangman fractures are fractures of the odontoid process, which destabilises the A/P axis of the spine and damages/severs the cord at C2 resulting in death. To fracture the odontoid requires pre existing pathology or severe trauma to the Neck. Assuming Epstein didn’t suffer from rheumatoid arthritis or PMR it doesn’t seem feasible that he could hang himself from a bedsheet which
@srh88 said there were no anchors for. If the hyoid has fractured the cause of death will be pending which is what we currently see. Strangulation often fractures the hyoid but rarely the odontoid process, the pathologist will work out what happened.