The evaluation of penetrating neck injury has evolved dramatically from mandatory operative exploration of Zone II injuries that penetrate the platysma to selective management based on physical examination and adjunctive studies. More recently, CT angiography has emerged as an efficient, noninvasive method of evaluating penetrating neck injury. We retrospectively reviewed our experience over 10 years with the management of penetrating neck injury. One hundred thirty cases were reviewed with 34 undergoing CT angiogram (Group CTA) and 96 with no CT angiogram (Group nCTA). Group CTA had significantly fewer neck explorations, 1 (3%) versus 32 (33%), P < 0.001. Negative explorations were significantly higher in nCTA as well, with a rate of 22 per cent versus 0 in CTA (P < 0.01). The use of angiogram and esophagram was also significantly lower in CTA versus nCTA (P = 0.02 and P = 0.04). Of the 34 patients in CTA, 4 (12%) also underwent angiography and 4 (12%) received a contrast esophagram. Of the 64 patients in nCTA who did not undergo a neck exploration, 19 (29%) underwent angiography, and 17 (26%) received a contrast esophagram. The use of CT angiogram increased over time with a concomitant decrease in the rate of neck explorations.