Technologic advancements in radiographic imaging and interactive computers have allowed image-guided systems to be developed, which have been used to characterize surgical anatomy with greater accuracy and detail. Early generations of image-guided systems were difficult to use; however, recent modifications have allowed it to become more user friendly and less cumbersome. As a result, the application of image-guided systems has expanded and its use has become more frequent. Two major designs, optical and electromagnetic, have been used. Although most image-guided systems use computed tomography digital images, magnetic resonance image-based image-guided systems serve a unique and useful purpose. Future directions for image-guided surgery include smaller flexible instrumentation and simplified registration. As image-guided systems continue to evolve, they will enable otolaryngologist to broaden the horizon of minimally invasive techniques and operations.