J Forensic Sci, 2019

doi: 10.1111/1556-4029.14221
CASE REPORT Available online at: onlinelibrary.wiley.com

PATHOLOGY/BIOLOGY

Sydney C. Pawsey,1 B.S.; Catherine G. Wilson,2 B.S.; Wendy M. Gunther,3 M.D.; and
Amy P. Fantaskey,1 M.D.

Suicide by Close-Range Gunshot Wound to

the Bridge of the Nose

ABSTRACT: Suicidal gunshot wounds to the nasal bridge are rare, particularly at close range (defined as muzzle of the weapon not touch-
ing the skin surface, but near enough to deposit soot and stippling). Previously reported suicidal gunshot wounds to the nose have been through
the left nostril (Forensic Sci Int 1995;71(1):25–31; J Forensic Radiol Imag 2013;1(2):63–7). The death of a 26-year-old man with a close-range
gunshot wound to the bridge of the nose was deemed suicide due to history, scene, and autopsy findings. These findings included previous sui-
cidal ideation, texted and written notes, the decedent’s cross-legged position seated on the floor, the trajectory of the bullet through his head
and into the ceiling fan and roof above him, and acute alcohol intoxication. This decedent may have been intending a hard contact forehead
location but inadvertently fired the gun into the bridge of his nose while bending forward, prior to contact.

KEYWORDS: forensic science, forensic pathology, suicidal gunshot wound, facial, bridge of nose, close-range fire, manner of death

Suicidal gunshot wounds to the nose are rare; to our knowl-
edge, a suicidal gunshot wound to the bridge of the nose has not
been previously reported. Close-range gunshot wounds (wounds
from rifled weapons that are close enough to deposit soot and
stippling on the skin, without muzzle contact) have been
reported in suicides, although they are infrequent. Characteristics
such as a muzzle imprint, soot, or stippling can help in creating
a rough estimate of the range of fire; a more accurate assessment
can be obtained by test firing the weapon and ammunition, and
comparing test patterns with those seen on the skin surface (1).
If investigators want to determine a precise range of fire for a
gunshot wound with soot and stippling on the skin surface, bal-
listics examiners may be consulted to produce similar patterns
by test firing the weapon. These patterns, however, are not pre-
cisely the same as those produced on the skin. Gunshot wounds
may be described as “contact/near contact”, with features such
as a muzzle imprint or a partial muzzle imprint with soot; “close
range”, without a muzzle imprint, but with soot and stippling;
“intermediate range”, with stippling without soot; or “distant or
of undetermined range”, with an entrance defect without muzzle
imprint, soot, or stippling. This is referred to by some authors as
“pathological range of fire” (2). The distance of the weapon
from this injury was not determined through ballistics testing;
autopsy examination identified characteristics inconsistent with
1
Physician Assistant Program, Eastern Virginia Medical School, P.O.
Box 1980, Norfolk, VA, 23501.
2 the bullet to preclude further damage to the dwelling.
Doctor of Medicine Program, Eastern Virginia Medical School, P.O.
Box 1980, Norfolk, VA, 23501.
3
Tidewater District, Commonwealth of Virginia, Office of the Chief Medi-
cal Examiner, 830 Southampton Avenue, Ste. 100, Norfolk, VA 23510.
Corresponding author: Wendy M. Gunther, M.D. E-mail: wendy.gunther@
vdh.virginia.gov
Received 22 Aug. 2019; and in revised form 30 Sept. 2019; accepted 9
Oct. 2019.
hard contact, but consistent with close range. Pathologists in this
jurisdiction determine the cause and manner of death utilizing
scene, autopsy, and ancillary information; after review of all
available information, this case was deemed a suicide. This case
report describes the scene investigation, history, and autopsy
findings in a case of a suicidal close-range gunshot wound to
the nasal bridge.
Case Report
Police were called to a home for a welfare check due to dis-
turbing text messages. The decedent, a 26-year-old white male,
was found on his bedroom floor by the foot of the bed (Fig. 1);
he was pronounced dead at the scene. The decedent was seated
in a partially cross-legged position, hunched to his right, over
blood pooled on the carpet. A pair of earbuds was lying across
his lap; a 0.45 caliber handgun lay with the muzzle resting on
his ankle. Near the body was a cell phone, a laptop open to a
blank screen, a spent shell casing, a cartridge, an empty bottle of
whiskey, a can of alcoholic seltzer, and an empty glass atop a
notebook with writing.
The police described the scene to be without evidence of
struggle or foul play. Blood on the body was dry. There was a
single gunshot wound to the bridge of the decedent’s nose, and
a second wound noted in the back of the head. A hole was pre-
sent in the ceiling fan blade, which aligned with holes in the
ceiling and roof. The investigating agency declined to retrieve
Although the decedent had no medical diagnosis of depres-
sion, he had previously talked about suicide, and may have been
seeking help for depressive symptoms, as a card with mental
health contact information was affixed to the refrigerator. Previ-
ously, he was known to become agitated whenever his mother
left town, as was the situation at the time of his death. Multiple

© 2019 American Academy of Forensic Sciences 1

2 JOURNAL OF FORENSIC SCIENCES

FIG. 1––Scene photograph demonstrating body position including weapon,

earbuds in the lap, written notes, and alcohol containers.

FIG. 2––Close-range entrance wound with a 3 cm oval of soot and

handwritten notes stating his intent to die were found at the 7 9 6 cm oval of stippling.
scene, and he had left text messages to family stating, “Nothing
is working.”
External examination at forensic autopsy revealed a normally
developed, slender male appearing his stated age. A gunshot
wound with an abrasion collar and skin splits was observed in
the midline of the nasal bridge; there was no muzzle imprint
(Fig. 2). Soot and stippling surrounded it, consistent with a
close-range entrance wound. Soot was more prominent across
the glabella than across the nasal tip (Fig. 2). The soot oval,
measured from the center of the wound to the glabella, had a
diameter of about 3 cm; the stippling oval measured about
7 9 6 cm. Right periorbital ecchymosis was noted. A stellate
deformation of the occipital scalp was consistent with an exit
wound (Fig. 3). Inspection of the hands revealed no evidence of
defensive injuries; blood spatter was present, with no blood pre-
sent on the central palm of each hand.
Radiographs and complete autopsy demonstrated the trajectory
of the bullet. The bullet entered the skull through the nasal
bones and both choanae, accessing the cranial vault through the
sphenoid bone inferior to the pituitary sella and optic chiasm. It
perforated the brainstem and cerebellum, causing superficial
damage to the occipital lobes, and exited the skull through the
left occipital bone near the midline (Fig. 3). The skull exit was a
comminuted, externally beveled defect in the left occipital bone
just superior to the tentorium, medial to the stellate scalp exit
(Fig. 4). Associated injuries included multifocal subarachnoid
hemorrhage and cerebral contusions. Radiating skull fractures
into the right supraorbital plate were responsible for periorbital
ecchymosis. Blood extravasation into the lungs, right greater
than left, was consistent with the decedent’s rightward tilted
position. Routine autopsy with special dissection of the neck did FIG. 3––Exit gunshot wound, after shaving surrounding scalp hair.
not reveal additional external trauma, natural disease, or any evi-
dence of strap muscle bruising, laryngeal cartilage injury, or
hyoid bone fracture. Police obtained gunshot residue test swabs
Discussion
at the scene from the hands of the decedent; the result was posi-
tive. Postmortem alcohol testing identified a blood alcohol level In the United States, suicide is most often completed by use
of 0.150% by weight by volume, and a vitreous humor alcohol of a firearm; the most common location is the head, followed by
level of 0.180% by weight by volume. the chest, then the abdomen (3). Multiple studies have
 PAWSEY ET AL.
FIG. 4––Trajectory rod in skull.
investigated the location of self-inflicted gunshot wounds to the
head. In a Turkish study reported in 2007, among gunshots to
the head, the right side of the cranium was the most common,
followed by the forehead and then underneath the chin (4). In a
more recent American study discussing facial gunshot wounds
(excluding the temples), it was noted the most common areas
were submental followed by intraoral (5). There have been two
reports of gunshot wound suicide through the nostril (6,7),
although none through the bridge of the nose. A 1995 case
report documented a suicidal gunshot wound with entry in the
left nostril (6). A second case was reported in Switzerland in
2013, also through the left nostril (7). Both of these cases were
hard contact gunshot wounds deemed to be suicide. This case
reports a nasal bridge gunshot wound from a distance that pro-
duced soot and stippling without a muzzle imprint (close range,
without characteristics of hard contact), a finding that is uncom-
mon in suicide (3).
Multiple risk factors have been identified in persons who
attempt or complete suicide, with two of the most common
being alcohol use and depression. In a study of 406 suicides by
gunshot to the head, blood alcohol was identified in 40% of the
cases (8). When comparing attempted to completed suicides,
those who completed the suicide were at least two times more
likely to leave a suicide note versus those who attempted suicide
(9). Although this decedent had no previous medical diagnosis
of depression, he left multiple notes describing his intent to die,
. SUICIDAL GUNSHOT WOUND TO THE BRIDGE OF THE NOTE 3
he texted his mother about his life “not working out”, he was
known to become upset when his mother was out of town, he
had spoken of suicidal intent previously, and he was imbibing
alcohol.
Although this case demonstrates many common attributes of
suicide as documented in previous studies, including suicidal
ideation, alcohol consumption, and written notes, it differs in its
range of fire and its unusual location; a close-range suicidal gun-
shot wound through the nasal bridge has not been previously
reported. Homicide was given consideration, but the manner of
death was deemed suicide due to the combination of the autopsy
findings, circumstances, and scene observations.
The forehead has been documented as a common entry site
for hard contact gunshot wounds, and this may have been the
decedent’s target. If he bent forward in the seated position to
place the muzzle to his forehead, it is possible that his intoxi-
cated state may have impaired his coordination, leading to pre-
mature, close-range discharge of the weapon into his nasal
bridge. The scene trajectory through the ceiling fan, the pattern
of soot across the glabella with stippling to the nasal tip, and the
trajectory determined by the autopsy, supports this speculation.
Measurement of limb length is a recommended practice when
a longarm gun is involved in a suicide. The practice is not as
relevant when injury is due to a handgun. A disabled decedent
may be unable to lift a short-barreled weapon to the temple or
forehead; in such cases, limb length measurement may be help-
ful. This young decedent had no recognized disability. As such,
the limb length was not measured. Police investigators also
declined to pursue further ballistic testing.
Although this is an unusual location for a suicidal gunshot
wound, investigation, scene, and autopsy evidence support a
manner of suicide.
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