Gunshot wounds to the head and neck contribute to substantial medical, economic, and social problems in the United States today. The treatment of these patients requires the contemporary head and neck surgeon to be precisely informed in anatomy, wound ballistics, resuscitation, and surgical decision making. Ninety recent cases at the University of Texas Health Science Center affiliated hospitals in Houston were reviewed and are reported. Data show substantial trends in patient demographics and corroborate other reports in the trauma literature. Controversies in patient management continue, but current evidence favors a protocol of selective surgical exploration.