What is the surest sign of antemortem hanging?

The surest sign of antemortem hanging is the dribbling of saliva. This occurs because the individual is likely to be in a state of consciousness until the point of suspension, leading to involuntary drooling as a result of stress or pressure on the throat. Dribbling of saliva can indicate that the person was alive and struggling prior to death, which is characteristic of antemortem hanging, as opposed to postmortem events.

The other signs listed are not as definitive for indicating antemortem hanging. Paltauf hemorrhages, for example, are specific types of hemorrhages associated with hanging, but they may not be present in all cases. Skin lacerations could occur postmortem as a result of the body's position once the suspension is stopped. Rigor mortis is a postmortem change that indicates the state of the body after death and does not provide direct evidence of the circumstances leading to death.