There are relatively few published reports of Horner’s syndrome following penetrating injury to the neck. We present the case of a 19-year-old female sustaining a Zone 2 neck laceration with Horner’s syndrome due to complete transection of the sympathetic trunk. Nerve repair was performed with an interposition cable nerve graft using ansa cervicalis and resulted in complete recovery at 13 months follow-up. Neuropraxia cannot be differentiated from nerve transection clinically or radiologically and given the potential for complete recovery after nerve repair, we advocate for surgical exploration in all cases of penetrating neck injury with Horner’s syndrome.