In each case, the pattern of fractures was examined and is described in this paper. Based on these cases, the authors suggest a possibly diagnostic bilaterally symmetrical pattern of fractures for midline contact gunshot wounds in the skull. The authors propose that clues to an intraoral (through the mouth) or submandibular (under the chin) gunshot wound, suggestive of suicide, may exist in the presence of some or all of the following skull fractures: tripod fractures of the zygomatics, vertical fractures of the maxillae, vertical fractures of the mandibular body, a projectile path through the posterior palate, wedge-fractures of the mandibule, and symmetrical fracturing of the supraorbital region. In three of the five cases, the skulls did not show the classic gunshot entry and/or exit injuries, which made the reconstruction of the death histories difficult. These cases, however, did exhibit important evidence in the form of bilaterally symmetrical fracture patterns. The authors conclude that this distinctive pattern resulted from a contact midline gunshot wound to the head, in which there was a centralized explosive dispersion of gases. This hypothesis was supported by the symmetrical fracture pattern in case 1, which was determined by autopsy, and corroborated by a clear exit wound, to be a midline event, as well as by case 5, which had entrance and exit wounds located along the midline of the skull. The weapons found at the death scenes were two high-powered rifles, two shotguns, and one handgun. 7 figures and 45 references