Injuries to the internal carotid artery are rare complications following orthognathic surgery. Complications th at have been reported include thrombosis, hemorrhage, arteriovenous fistulas, and false aneurysms. Direct trauma to the artery can occur during the pterygomaxillary dysjunction or the maxillary downfracture if a basal skull fracture ensues that involves areas such as the foramen lacerum and carotid canal. Indirect trauma can follow sudden forceful stretching of the internal carotid artery in the neck over the upper cervical spine by cervical hyperextension with contralateral rotation of the head. An intimal laceration can be a site of occlusion of the vessel, a source for cerebral emboli, or a site for formation of a traumatic or dissecting aneurysm. A more severe disruption of the layers of the walls of the internal carotid artery could lead to hemorrhage or the formation of an arteriovenous fistula.