Complete or incomplete decapitation as a consequence of suicidal hanging is very rare, few cases having been reported in the worldwide literature. Posthanging decapitation is typically related to a drop of several meters. Three cases of complete decapitation and one case of incomplete decapitation by suicidal hanging are reported with particular emphasis on internal findings and vital reaction patterns. Personal, circumstantial, autopsy, and toxicological data were analyzed to define basic characteristics of such extreme injuries. The crucial factor for the state of decapitation itself is the kinetic energy of the falling body, the strength of the human neck tissue, and the diameter and elasticity of the used ligature. Results of our case study suggest Simon's hemorrhage and air embolism as useful autopsy findings in posthanging beheading cases. Simon's hemorrhage was demonstrated in three cases of four. The test for air embolism was positive in all four cases.