Objective: To evaluate the role of physical examination in decision making for exploring patients with penetrating zone II neck injury.Methods: This was a cross-sectional study being performed in a level I trauma center between 2006 and 2010. The present study reviewed the records of 150 patients with penetrating neck injuries. Of 46 cases with zone II deep platysma neck injuries, 3 patients died before taking any significant medical measure.Results: Thirty of 43 patients (70%) presented with hard sings while 13 (30%) did not show these sings. All patients underwent neck exploration. Two patients (4.6%) without hard sings exhibited positive findings, whereas 29 cases (67%) with hard sings reported positive on exploration.Conclusion: Briefly, we hold the view that it seems reasonable to follow an algorithmic approach by using physical examination of the patients with zone II penetrating neck injuries. This prevents unnecessary exploration for management of such patients.