Sixteen cases with soft palate lacerations and neurologic sequelae secondary to internal carotid artery injury are presented and reviewed. In all 16 cases, it is probable that blunt trauma to the internal carotid artery produced an intimal tear causing an intraluminal thrombus to form. Within 48 hours of injury all patients demonstrated varying degrees of neurologic deficit with 5 deaths. This article recommends the following treatment protocol for these cases: 1. admission for 48 hours observation; 2. early ultrasound or angiography at first sign of neurologic changes; 3. immediate anticoagulation if internal carotid artery occlusion is discovered; 4. surgery is usually inappropriate as the thrombus presents in the inaccessible skull base or may embolize during attempted removal. The present case represents the result of this formulated treatment protocol.