Head and neck tuberculosis (HNTB) represents a significant clinical challenge, accounting for 10-15% of extrapulmonary tuberculosis cases, with cervical lymphadenopathy comprising 87.9% of presentations and laryngeal involvement affecting 8.7%[1]. This comprehensive narrative review synthesizes contemporary evidence from meta-analyses, cohort studies, and WHO guidelines (through 2025) to address diagnostic paradigms, histopathological correlations, imaging modalities, immunopathogenic mechanisms, and evolving therapeutic strategies including shorter regimens for drug-resistant strains. Analysis of 104-288 cases across multiple tertiary centers demonstrates cure rates of 94-96.8% with standard anti-tubercular therapy (ATT) and 85-92% with shorter multidrug- resistant TB regimens. Early multidisciplinary intervention combining medical management with selective surgical intervention yields superior outcomes, underscoring the imperative for heightened clinical suspicion in endemic regions and systematic diagnostic protocols to minimize diagnostic delay (currently 2-6 months average) [2][3].