Close-Range Gunshot Wound to the Nasal Region with Intracranial Trajectory: A Forensic Case Report

Abstract

Introduction: Gunshot wounds (GSWs) to the head often result in death due to severe damage to internal brain structures and subsequent bleeding. Accurately reconstructing the path of the bullet is crucial for medicolegal inquiries, especially when the entry point is unusual. GSWs entering through the nose are rare and pose diagnostic difficulties, as the bullet may pass through the paranasal sinuses and the front base of the skull before impacting critical brain areas. Combining autopsy results with radiological imaging is vital for an objective assessment of the cause of death.

Case: A middle-aged man was discovered dead and underwent a medicolegal autopsy. The external examination revealed a circular gunshot entry wound at the midline of the nose, measuring around 1.0 × 0.8 cm, with a noticeable abrasion collar, but no exit wound was found. The presence of cyanosis in the lips and nail beds, along with fixed livor mortis in the posterior region and generalized rigor mortis, was noted. The internal examination of the skull showed a fracture at the base and considerable intracranial bleeding, mainly in the posterior cerebral area, accompanied by vascular congestion. A metallic projectile approximately 0.5 × 0.9 cm in size was retrieved from the posterior cranial cavity, and radiographic imaging confirmed its location within the skull. The reconstructed path of the bullet extended from the nasal entry point through the anterior cranial base into the posterior intracranial area. The cause of death was established as severe traumatic brain injury resulting from a close-range gunshot wound.

Discussion: Unusual entry points like the nasal area can make it difficult to analyze the trajectory and conduct medicolegal evaluations. Features such as an abrasion collar, lack of an exit wound, skull base fracture, and a retained projectile indicate a close-range ballistic path from front to back, with energy dispersing inside the skull. Radiological verification improved the accuracy of projectile positioning and reinforced the forensic findings.

Conclusions: This case highlights the significance of a thorough autopsy and radiological analysis in precisely determining the trajectory and identifying the definitive cause of death in unusual cranial gunshot wounds.