Background: Sphenoid sinus is the most inaccessible paranasal sinus, enclosed within the sphenoid bone and intimately related to numerous vital neural and vascular structures. Anatomic variation of the sphenoid sinus is well documented and may complicate surgery in such a place. Objective: To assess the reliability of preoperative computed tomography (CT) in determination of the distance between the posterior wall of maxillary sinus (PWMS) and the sphenoid sinus ostium (SSO) in the coronal plane. Patients and methods: This was aprospective study of the distance between the SSO and the PWMS in the coronal plane, which was measured both radiologically in preoperative CT and intraoperatively during endoscopic sinus surgery for patients in need for middle meatal antrostomy and sphenoid sinusotomy at the same side. Distances obtained by both techniques have been tested for the degree of correlation. Number of the included patients was 25. Results: Forty four nasal sides were included in the study. The mean distance between the sphenoid sinus ostium and posterior wall of maxillary sinus in the coronal plane was 6.6 ± 1.8 mm when measured by preoperative CT and 6.9 ± 1.9 mm when measured directly during surgery. No significant difference was found between the mean distances measured by both techniques (p = 0.246) with good agreement between them (r = 0.864). Conclusion: Preoperative CT may be a reliable tool to preoperatively determine the difference in depth between the PWMS and the SSO.