Recent advances in the understanding of mucociliary activity and the pathophysiology of the nasal cavity and paranasal sinuses have revolutionized the surgical management of chronic and/or recurrent sinusitis. Meticulous radiographic delineation of the small structures in this region, coupled with endoscopic evaluation, provides detailed preoperative information regarding morphology and pathology. This information has led to more focused endoscopic surgical procedures, which have dramatically reduced patient morbidity. As a consequence, there is now worldwide interest among otolaryngologists in the radiologic definition of paranasal regional anatomy. For effective interactions between radiologist and otolaryngologist, the former must be prepared to render interpretations that address these "microanatomic" locales. This communication is directed at familiarizing the radiologist with these observations and concepts, considering both normal and disturbed anatomy with their attendant pathophysiologic and therapeutic implications.