Abstract             Background: A perplexing diagnostic and therapeutic dilemma is often presented by masses involving glandular and nodal structures of head and neck - lymph nodes, thyroid gland and salivary glands. Fine needle aspiration of such masses is a rapid, direct and safe adjunctive procedure for obtaining material for cytological analysis. Objectives: To study the diagnostic efficacy of FNAC in the head and neck lesions and correlate it with histopathology. Material and Methods: It is a study of 186 cases of head and neck area referred to the Department of Pathology of tertiary care centre Bhopal. The cytological diagnosis was compared with histopathology. The false positive/negative data was analyzed to calculate the sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of the study. Results: The study included 186 cases between 1-77 years in which male to female ratio was 1:1. Maximum numbers of cases were from lymph nodes, 118 (63.50%) followed by thyroid and then salivary gland. The overall accuracy was 95.45% with sensitivity of 86.36% and specificity of 100%. Positive and negative predictive values were 100% and 93.61% respectively. Conclusion: FNAC is an excellent first line method for investigating the nature of palpable lesions in the head and neck region. It can even obviate the need for surgery in some of the non-neoplastic lesions and help surgeon for better planning of surgical procedures.