Vascular complications in orthognathic surgery may include intraoperativehaemorrhage, arterial wall dissection and ischaemia and avascularnecrosis of mobilized and repositioned segments.A 23 year old male underwent a bilateral sagittal split osteotomy toadvance the mandible. Intra-operatively, marked haemorrhage occurredfrom the medial side of the left ramus. Haemostasis was achievedsurgically (by packing) and with anaesthetic assistance (tranexamic acid)and after completion of the procedure, the patient was transferred tothe ICU.Several weeks later, an MRA scheduled to exclude pseudoaneurysmformation, confirmed the presence of this vascular anomaly. It involvedthe left maxillary artery and was managed by embolization using atransfemoral catheter by interventional radiology. The patient made anunremarkable recovery and has since been debanded.This case is presented to highlight the risk of this vascular complicationfollowing marked intraoperative haemorrhage and the role of imaging.A review of the incidence and management of these vascular eventsfollowing orthognathic surgery will be presented.