Abstract
Although the overall incidence is low, penetrating neck trauma can result in devastating injuries. The traditional zonal approach is being increasingly abandoned in favor of selective approaches, especially as mandatory exploration can result in non-therapeutic interventions and associated complications. Additionally, the trajectory of the missile cannot be accurately assessed based on external wounds. Decision-making using the hard and soft signs of trauma and increased resolution of imaging modalities are progressively supplanting the older zonal approaches. Here we discuss the modern diagnostic approach, operative interventions, and the appropriateness of observation.