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Persistent cervicofacial masses require tissue sampling to guide treatment. While open biopsy is invasive, fine-needle aspiration cytology is insufficient to establish a diagnosis in rare clinical or pathological conditions. The cutting needle biopsy (CNB) is not a widely used technique in the head and neck, and its diagnostic effectiveness in uncommon cervicofacial lesions has not been evaluated as yet.This was a systematic clinicopathologic quality assessment study. We performed 347 CNBs in 160 patients with unclear masses including 29 patients in whom final diagnosis revealed rare conditions.We experienced 100% success in obtaining high-quality tissue cores. CNB enabled accurate diagnosis even in highly exceptional lesions. One false negative result was recorded.Adequate assessment of rare lesions is one of the major benefits of CNB over fine-needle aspiration. CNB can therefore be recommended as the initial procedure in cervicofacial masses, even if an uncommon causation is presumed.