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Penetrating neck trauma with laryngotracheal injury carries high mortality secondary to the loss of the airway. While many patients die from these injuries before reaching the hospital, improved prehospital care has increased the number of patients seeking surgical evaluation for penetrating neck trauma. As many as 50% of patients presenting with gunshot wounds and 10–20% of patients with stab wounds will have significant injuries. Injuries to multiple structures in the neck are common given the close proximity of major vascular, aerodigestive, nervous, and endocrine structures (Fig. ). Important aspects of initial care include both hemorrhage control and airway control along with early and thorough diagnosis of all injuries.