A prospective observational study was conducted in a zonal care hospital probing the role of FNAC in palpable head and neck lesions & its diagnostic utility which can differentiate the various neoplastic and non neoplastic lesions of head and neck very cost effectively. To study diagnostic utility of fine needle aspiration cytology(FNAC) in head and neck lesions. A one year prospective observational study carried out at a zonal care hospital, which included a total of 120 patients reported with head and neck masses in the Otorinolaryngology OPD. Out of 120 FNACs, 38 (31.66%) cases were of thyroid origin, 35 (29.16%) cases included cervical lymph nodes, 34 cases (28.33%) arised from soft tissue and 04 (3.33%) from salivary glands. Thyroid lesion involvement (31.66%) was more common than any other lesion, out of which 84.21% were colloid goitre, 7.89% were Hashimoto’s thyroditis, 5.26% follicular neoplasm and 2.56% papillary carcinoma of thyroid. Amongst the lymph node swellings, 13 cases (36.11%) were reactive/ nonspecific lesion, 12 cases (33.33%) were tuberculous granulomatous lymphadenitis, 16.66% were cases of suppurative lymphadenitis. In malignant lesions of lymph nodes, metastatic deposit of carcinoma and poorly differentiated carcinoma were the predominant pathology and lymphoma case was nil. FNAC of head and neck swelling is a worldwide accepted diagnostic modality. It is simple, inexpensive and rapid method for the diagnosis of head and neck lesion and avoids unnecessary surgery in the form of excision biopsy for diagnosis.