Background: Pneumatization of various bones around the nasal cavity results in the formation of paranasal sinuses. Varying degrees of pneumatization result in multiple variations of paranasal sinuses some of which are important from clinical, pathological and surgical perspective. The aim of the present study was to investigate the role of MDCT in detection of paranasal variants and their surgical and clinical impact. Methods: 100 patients with MSCT of the paranasal sinuses were included in this study. Patients having indications of incessant rhinosinusitis hard-headed to restorative treatment and would be candidates for endoscopic sinus surgery were included in this study. Results: The mean age of the studied patients was 30 years. There were no significant differences between males and females regarding agger nasi cell, Bulla ethmoidalis (P-value = 1.0), Concha bullosa (P-value = 0.75), crista galli pneumatization, Deviated nasal septum (P-value = 0.208), Frontal sinus agenesis (Pvalue = 0.62), Frontal sinus hypoplasia (P-value = 0.719), Haller cell (P-value = 1.0), Inferior turbinate pneumatization, Maxillary sinus hypoplasia, Maxillary sinus septation, Onodi cells (P-value = 1.0), Paradoxical middle turbinate (P-value = 0.470), Sphenoid sinus hypoplasia (P-value = 0.497), Sphenoid sinus septation, Superior turbinate pneumatization, Supraorbital cells, and presence of at least one abnormality (P-value = 0.203). Conclusion: Inspection of MSCT scans must be performed to identify anatomical variations involving the key area of the osteomeatal complex and frontal recess should be considered before surgical interventions.