Purpose: The purpose of this study was to defining the prevalence, size of incidence of different anatomical variations of the paranasal sinus (PNS) and nasal cavity among Sudanese patients and efficacy of CT scan in disease determination. Introduction: Disease of the PNS is a global public health problem, with the only treatment option available being endoscopic surgery. Previous studies have suggested that anatomical variations of the PNS are common in different populations; however, there is little information available to verify this. Hence, the objective of the present study was to determine the prevalence of different anatomical variations of the PNS and nasal cavity among Sudanese patients who were referred by ear, nose, and throat (ENT) surgeons for a computed tomography (CT)-aided study. Methodology: The total number of patients eligible for the study was 557; of these, 51 were excluded, 317 were in the study group, and 189 were controls. The CT images were carefully reviewed and discussed with the involvement of consultant radiologists, an anatomist, and an otolaryngologist. Results: Our results showed that there was extensive pneumatization of the frontal sinus (FS) in 37% of cases, a rudimentary FS in 11%, and absence of the FS in 12%. In addition, the Keros classification showed the FS to be normal in 55%, type I in 27%, type II in 10%, type III in 6%, and type IV in only 2% of patients. A large ethmoid bulla (EB) was found in 43% of patients, but the remaining 57% had a normal ethmoid sinus. Posterior ethmoid cells showed extensive pneumatization unilaterally in 5%, and bilaterally in 3% of patients; 92% were normal. Extensive pneumatization of the sphenoid was seen in 49% of patients, while the remaining 51% had a normal sphenoid. The sphenoid septum was attached bilaterally to the internal carotid artery in 6% and unilaterally in 21% of patients. A septate sphenoid sinus (more than one septum) was found in 33% of patients; the remaining 67% were normal. A bilateral hypoplastic maxillary sinus was seen in 23%, a unilateral hypoplastic maxillary sinus in 3%, extensive pneumatization in 17%, bilateral septation in 17%, unilateral septation in 19%, Haller cells in 33%, and normal anatomy in 67% of patients. Conclusion: A CT-aided study gives good results describing anatomical variations of the PNS in the Sudanese population and to the best of our knowledge, this is the first detailed clinical report on PNS in Sudan.