This chapter outlines the embryological development of the nose and paranasal sinuses, neurovascular and anatomical structures of the external nose, nasal cavity and nasal septum. It discusses a surgically relevant approach to the paranasal sinus anatomy and focuses on fixed anatomical landmarks and the concept of the horizontal and vertical components of the paranasal surgical box. The primitive nasal cavity and mouth are initially separated by the bucconasal membrane. This membrane gradually thins as the nasal sacs extend posteriorly and eventually breaks down to form the choanae. The maxillary sinus appears as a shallow groove expanding from the primitive ethmoidal infundibulum into the mass of the maxilla. The frontal sinus is the most variable sinus in terms of size and shape. Pneumatization of the frontal bone begins during the 16th week of gestation originating from the anterior ethmoid complex. The thickness of the skin and soft tissues of the nasal bridge vary according to individual skin type and anatomical location.