Congenital abnormalities of the nose can occur with or without respiratory obstruction. Nasal obstruction generally is detected in the neonatal period, and the examination of choice is CT. The results of CT will determine not only the cause of obstruction but also the surgical approach. Congenital anomalies of the nose with no respiratory obstruction generally appear later in life and have characteristic morphologic features. True midfacial clefting is a complex syndrome that is accompanied by intracranial abnormalities. In these patients, evaluation of the face might require both CT and MR imaging, but the brain is better examined with MR imaging. Abnormalities involving the prenasal space usually manifest as masses in the nose. All congenital abnormalities of the nose are due to discrete faults in the embryologic development of the face.