Background: Fine needle aspiration cytology (FNAC) is a well-established, minimally invasive diagnostic procedure used to evaluate head and neck lesions. It provides quick, reliable differentiation between benign and malignant lesions, guiding appropriate management and treatment strategies. Objective: This study aimed to analyze the spectrum of head and neck lesions diagnosed by FNAC at a tertiary care center, assess the diagnostic accuracy of FNAC in distinguishing benign from malignant lesions, and identify demographic trends and lesion distribution patterns over three years. Methods: A retrospective analysis was conducted on FNAC data from 500 patients between January 2015 and December 2017. Demographic data, lesion location, cytological diagnosis, and histopathological correlation were analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess FNAC's diagnostic accuracy. Results: Inflammatory/reactive lesions were the most common (40%), followed by neoplastic lesions (35%) and cystic lesions (15%). FNAC demonstrated high diagnostic accuracy, with a sensitivity of 92% and specificity of 95%. There was a significant association between age and malignancy, with older patients showing a higher likelihood of malignancy (p<0.05). Conclusion: FNAC remains a valuable diagnostic tool for head and neck lesions, offering high diagnostic accuracy. Its continued use is recommended in clinical practice for the early detection of malignancies and effective patient management.