Six hundred thirty-two cases of penetrating wounds of the neck were analyzed in this study in order to re-evaluate our current concepts in the management of these injuries. There were 35 deaths in this series, an overall mortality rate of 5.5%. However, in the last 10 years there were only 13 deaths among 407 patients, a 3.2% mortality rate. Early exploration was performed in 507 patients, and 125 patients were observed. Explorations revealed a total of 625 separate injuries. In 142 explorations, no injury was found. There was no mortality or significant morbidity in these patients with negative explorations. Patients who presented with obvious vascular or visceral injury were immediately explored. Those wounds without obvious injury were either explored or observed, depending on the index of clinical suspicion based on awareness of the innocuous presentation and difficulty in diagnosing esophageal injuries. The mortality rate is a function of multiple factors. Its decrease over the past 25 years is related to many improvements in our health care system. Our own decrease in mortality rate can be attributed in part to decreased transportation time resulting in less blood loss. A greater awareness of esophageal injuries was another factor. No conclusions are possible as to the feasibility of conservative management based upon the mortality rates alone; however, on examination of our experiences with penetrating wounds of the neck, it appears that a significant number of patients when carefully selected by trained personnel can be safely managed with observation.