Aims Penetrating neck injuries (PNI) have increased following the COVID-19 lockdowns in Melbourne. PNI are more commonly self-inflicted with disproportionate impacts on young men. This retrospective review characterises how the intent of PNI (self-inflicted, accidental, assault) influences the presentation, management, and outcomes of such injury. Methodology Retrospective data on trauma patients presenting with PNI to our institution was collected from Jan 2016 to Jan 2025. Patient demographics and clinical management of PNI was extracted and categorised as per intent of PNI (self-harm, assault, accident). Subgroup analyses were performed in SPSSv30 using non-parametric tests. Results 95 patients with the vast majority male (83.2%) with a median age of 37. Following the first Victorian COVID-19 lockdown in 2020, self-harm accounted for a higher proportion of PNI cases (50%) relative to institutional data collected between 2008 and 2018 (36.3%). Accident-related PNI cases were precluded from sub-group analyses due to low sample size (n=3). Zone II injuries constituted the majority of self-inflicted PNI presentations (73.7%), with higher incidence of vessel damage requiring vascular repair (14%) and aerodigestive tract injury (21%) relative to Zone I or II injuries. Self-inflicted PNI was significantly more likely to occur with an underlying psychotic disorder, present with haemodynamic compromise, and require surgical exploration as compared with patients presenting due to assault. There were no significant differences in ICU admissions or functional outcomes pertaining to speech and swallow between the two groups of intent. Conclusion Self-inflicted penetrating neck injuries are presenting at an alarmingly higher rate since the COVID-19 lockdowns of 2020. Young men are disproportionately over-represented and often involve suicidal intent with concomitant drug and alcohol use. Many require rapid exploration in theatre but only 1/8 (16%) require early tracheostomy.