Location of Wounds in Self Inflicted Firearm Injuries

Certain entry wound sites are characteristic of, but not exclusive to, suicide (37,59). Various sites of predilection—i.e., those accessible to the victim—have been observed on the head, chest, and abdomen (20,35,59,102). The head predominates in many studies (18,19,21,23,33,34,49,59,63,66,95,98,102,117). The temple region (right to left) is the most common site (21,46,50,51,66,101). For example, in a Texas study, the following distribution was noted: head wounds, 83.7% (right temple, 51.5%; mouth, 20.6%; forehead, 8.7%; left temple, 6.3%; under chin, 4.8%; back of head, 4%; neck, 1.8%; eye, 0.5%; other, 1.8%); chest, 14%; abdomen, 1.9%; and a combination, 0.4% (32). In a study by Eisele et al., the following distribution was noted: head, 74% (right temporal, 39%; left temporal, 5%; mouth, 9%; midfrontal, 8%; submental, 3%; right parietal, 3%; left head not otherwise specified, 2%, chin, orbit, other frontal, right head not otherwise specified, 1% each; nose, occipital, left parietal, <1% each); neck, 4%; chest, 18%; and abdomen, 4% (98). Temple wounds favor suicide, but homicide and accident are possible. One study showed that 47% of suicides involved the temple,

Fig. 17. Angled near contact shotgun wound of left chest (entry—arrowhead). (A) Soot (arrow) is seen on the medial aspect of the wound, which was closer to the angled muzzle. (B) Radiograph confirms that the pellets traveled laterally, i.e., to the left of the victim. Note "billiard ball" effect.

Fig. 17. Angled near contact shotgun wound of left chest (entry—arrowhead). (A) Soot (arrow) is seen on the medial aspect of the wound, which was closer to the angled muzzle. (B) Radiograph confirms that the pellets traveled laterally, i.e., to the left of the victim. Note "billiard ball" effect.

compared with 18% of homicides and 25% of accidents (30,37). Some studies show that a mouth entry site is more common if long guns (rifles, shotguns) are used, but a Turkish study showed a handgun predominance (32,34,35,37,49,137,138). Another series showed that the temporoparietal and temple areas were favored when rifles were used (98). A Swedish series revealed neck entries were associated with long guns (37). A series from New Mexico showed long guns favored in facial wounds (cheek, submental area [139]). Chin entry wounds tend to be self-inflicted (30).

Fig. 18. Hard contact gunshot entry (.22-caliber rifle). Pencil-like area of searing extending inferiorly from entry.

Self-inflicted intraoral wounds are associated with soot deposition on the lips, teeth, or tongue (Fig. 21). Intraoral wounds can potentially be missed, particularly if rigor makes the mouth difficult to open (Fig. 22; ref. 137). Despite not being seen in some series, an intraoral wound does not exclude the possibility of homicide (30,37,137,140,141). Unlike a homicide, the tongue tends to be involved in suicidal intraoral wounds (Fig. 23; ref. 140).

Wounds to the back of the head favor homicide and are rarely seen in suicide (16,142). A Texas study showed that, in 10 such cases, 7 involved handguns, 2 used rifles, and 1 had a shotgun (32). Another series revealed that 2.5% of self-inflicted wounds were to the back of the head, compared with 14% of homicides (30). Other unusual entry sites are possible (16). These include the top of the head, nose, ear, eye, umbilicus, and back (37,46,51,57,66,117,143). An intrarectal wound raises the possibility of sexual paraphilia (see Chapter 3, Subheading 2.7.2. and ref. 56).

A self-inflicted chest wound tends to be precordial, whereas a wider distribution is observed in homicides (37,59,102).

Self-inflicted abdominal wounds tend to involve the upper quadrants (144).

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