Background: Positive identification is at the forefront of tasks for forensic practitioners when a set of remains is discovered. Standard means of identification include fingerprints, dental, and DNA analyses; however, additional methods are utilized by forensic practitioners to identify remains when these primary methods of identification are not applicable. Comparative radiography has become a frequently employed approach for positive identification, specifically focused on individualizing characteristics evident in human skeletal variation. Regions that display wide ranges of morphological variation within the human skeleton include the cranium as well as the thorax. With regard to the cranium specifically, paranasal sinuses have been recognized as unique features and are valuable for identification purposes. Objectives: This paper explores the basic information of the anatomy and development, range of variation, and the importance of paranasal sinuses in forensic contexts. Results: This article discusses how practitioners can best use the morphological information contained in the paranasal sinuses and how to compare the antemortem and postmortem datasets involving different imaging modalities for positive identification purposes, in order to provide practical concepts that may assist in cases where paranasal sinuses may be used for forensic human identification. Conclusions: Understanding the development of paranasal sinuses, the imaging techniques applied for their visualization, as well as the principles of identification, is key to conducting proper antemortem vs. postmortem comparisons and effectively utilizing paranasal sinuses in forensic identification contexts.