Penetrating neck trauma may be managed operatively or nonoperatively, depending on precise anatomic location. Conservative management of zone II injuries is currently an issue under debate. We present a brief case report followed by a description of the current strategies for operative exploration and diagnostic maneuvers in penetrating neck injuries. Support for both expectant and operative management of zone II injuries is given. We conclude that for zone II injuries, mandatory exploration by an experienced surgeon is a safe approach and that conservative management must be undertaken with extreme caution.