Patients presenting with a mass in the head and neck region require a tissue biopsy in order to make a histological diagnosis. Fine needle aspiration (FNA) offers a safe, well tolerated and inexpensive method of obtaining such a biopsy. When the patient is first seen in the clinic, the FNA can be performed, the result read and appropriate management instituted. The results of FNA biopsies of head and neck masses performed between May 1993 and June 1995, at the Department of Otolaryngology, Head and Neck Surgery in Saint James's Hospital, Dublin were reviewed. Of the 130 patients who had FNA biopsies performed, 78 went on to have surgical excision of the mass. To determine the accuracy of FNA biopsy in the diagnosis of head and neck masses at our unit, we compared the cytology result and the final histology report of these 78 patients. The overall accuracy rate of FNA cytology was 95 per cent, when compared to the final histology result. The accuracy rate was 87 per cent for malignant lesions and 95 per cent for benign lesions. No complications were encountered in this study. Based on our results and those of other studies, we recommended performing FNA in all patients presenting with a mass in the head and neck region.