Orthognathic surgery is a safe procedure with increasing indications during the past few decades. However, complications in exceptional situations can be serious and even lethal. In this article, we analysed the complications of orthognathic surgery with the aim to recognize and treat them appropriately. In all, 5025 cases of orthognathic surgery have been performed over a 25-year period. All the complications except trigeminal disorders, temporo-mandibular joint disorders, dental traumas, and bad splits were recorded with their corresponding management. In all, 73 complications were found including vascular complications, ophthalmic, infections, pseudarthrosis, and cranial base fractures. Complications in orthognathic surgery are rare. While many are manageable, some could have adverse outcomes. Each complication has its own treatment. Prevention can be achieved with perfect surgical techniques. However, some complications cannot be avoided even with skilled surgeons.