Background: Penetrating neck injuries (PNIs) derive their significance rather from their potentially lethal repercussions than their incidence.The evaluation and management of PNIs has been continuously evolving. Yet, the introduction of ever more advanced imaging especially multidetector computerized tomography (MDCT) as well as endovascular techniques has produced a paradigmatic shift in the management of such injuries. Aim of work:(1) To assess the efficiency of a tailored protocol in the diagnosis and management of patients with penetrating neck injuries. (2) To define the role of multidetector computerized tomography in the evaluation of such injuries.(3) To shed light on the role endovascular techniques in the treatment of the associated vascular injuries. (4)To discuss some points of controversies in the management protocols of PNIs. Patients and Methods: This study including patients presenting with penetrating neck injuries in the period from February 2012 to December 2013 to the casuality department in Kasr El.Ainy hospital , Cairo University , Egypt .Patients presenting with blunt neck injuries, anterior neck injuries not breaching the platysma, posterior neck injuries (posterior to the anterior border of the trapezuis), were excluded from the study.All patients were resuscitated using Advanced Trauma Life Support (ATLS). After resuscitation all patients were managed according to a tailored protocol followed at our hospital Results: Our study included 85 patients. 80 males and only 5 female ,mean age of 27,the mode of trauma was 43 stabs ,24 shotguns, 12 bullets &,6 motor car accidents. Twenty-two patients arrived unstable , while 63 patients were stable; 23 were asymptomatic and others were symptomatic (18 presented with hard signs and 22 presented with soft signs).Multi Detector Computerised Tomography was used in 53 cases , duplex in 25 cases, angiography in 6 cases ,esophogram in 13 cases ,larygoscopy&/or bronchoscopy in 3 cases . A total of 31 cases were managed conservatively, while 54 were managed operatively (3 patients were managed by endovascular intervention). There were 51 vascular injuries in 43 patients. Eight patients had pharyngo-esophageal injuries. Six patients had laryngo-tracheal injuries.The mean patients' hospital stay was 5 days. There were 3 cases of superficial infection, 2 cases of endoleaks, 1 case of missed brachial plexus nerve injury, 1 case of missed phrenic nerve injury and 2 related mortalities. Zones classification is loosing popularity in the initial assessment andmay be deceiving in slanting stabs and bullets injuries. The boom of MDCT and endovascular techniques will change the algorithms of management. (Our tailored protocol based on physical examination aided by MDCTseems safe and effective , so the use of a management algorithm that suitsthe needs and facilities available may improve the outcome of victims ofpenetrating neck injuries.