Approximately 5% of all cases of trauma involve injury to the neck. This relatively low incidence together with improvements in diagnostic modalities has led to continuing evolution in the management of neck trauma. Injuries to the neck can be the result of blunt and penetrating trauma. Both mechanisms can cause devastating injuries, with high associated morbidity and mortality. This review examines the airway, penetrating neck trauma, and blunt trauma. Figures show an algorithm outlining operative management of known or suspected injuries to the carotid arteries, jugular veins, pharynx, and esophagus, a tracheotomy hook used to retract the thyroid cartilage cephalad to facilitate placing the airway, the traditional division of the neck into three separate zones, exposure of structures in the anterior areas of the neck through an incision oriented along the anterior border of the sternocleidomastoid muscle, dissection of the sternocleidomastoid muscle carried down to the level of the carotid sheath, a balloon embolectomy catheter used to occlude the distal internal carotid artery at the skull base, a number of important structures encountered during distal dissection of the internal and external carotid arteries, options for repair of the arteries in the neck, exposure of the vertebral artery and the vertebral veins surrounded by the transverse processes of the cervical vertebrae, exposure of the distal vertebral artery via an incision along the anterior border of the sternocleidomastoid muscle, control of bleeding from vertebral artery injuries located within the transverse process of the cervical, approaching proximal vertebral artery via a supraclavicular incision, and an algorithm outlining management of known injuries to the vertebral artery, which are most often discovered by angiography. The table lists screening criteria for blunt cerebrovascular injury. This review contains 13 highly rendered figures, 1 table, and 37 references