The modern approach to patients presenting with penetrating injuries to the neck requires the cautious integration of clinical findings and appropriate imaging studies for formulation of an effective, safe, and minimally invasive modality of treatment. The optimal management of these injuries has undergone considerable debate regarding surgical versus nonsurgical treatment approaches. More recent advances in imaging technology continue to evolve, providing more accurate and timely information for the management of these patients. In this article the authors review both historic and recent articles that have formulated the current management of penetrating injuries to the neck.