Objective: Head and neck sarcomas are rare and diverse tumors, which less has been studied. Choosing a precise biopsy technique is of paramount importance to prevent unnecessary resection and morbidity for the patient. In this study, the aim is to assess the accuracy of two common techniques in dignity, histology, subtyping, and grading. Methods: In this retrospective study, patients discussed in Head and Neck MDT meetings between 2018 and April 2024 have been reviewed. Inclusion criteria were patients with an available diagnostic histopathology report as well as an available final histopathology report after surgical resection. Results: Ninety patients were included in the study. The accuracy of open biopsy in determining tumor dignity, histology, and subtyping were 95%, 90%, and 85%, respectively, which did not show a statistically significant difference with core needle biopsy with 86% accuracy in tumor dignity, 76 % in tumor histology and 76% in subtyping. However, the open biopsy was significantly superior to the core needle biopsy in terms of tumor grading (87% versus 62%). No significant difference between soft tissue and bone sarcoma was detected in diagnostic biopsy accuracy. Conclusion: Core needle biopsy is an accurate and safe option for the diagnosis of sarcoma tumors in the head and neck area. A larger sample size is recommended for future studies.