The nature and extent of congenital bony nasal obstruction is best determined by X-ray computed tomography (CT) imaging. Three-dimensional volume rendering of CT images provides an integrated perspective that can assist in clinical decision making and in operative planning. Clinical cases of choanal atresia and pyriform aperture stenosis are reviewed with their images. The authors propose this modality as an evolving standard for imaging of congenital bony nasal obstruction.