Since the introduction of functional endoscopic sinus surgery (FESS) in the United States in 1985, the information gained from imaging has proved imperative in understanding regional morphology and guidance of surgical procedures. More than 20 years later, the importance of imaging continues to be the anatomic detail afforded by this technology, the roadmap it provides in planning the surgery, and the morphologic detail it provides in recurrent disease. The latest development in CT technology, cone beam CT instrumentation, may change the way imaging of the nasal cavity and paranasal sinuses is performed in the future. These topics are discussed in this article.