<p>Orthognathic surgery is widely performed to correct dentofacial deformities and is generally associated with a low risk of vascular complications. This report describes a case of pseudoaneurysm of the descending palatine artery following orthognathic surgery. The patient was a woman in her 50s who was diagnosed with dentofacial deformity and underwent orthognathic surgery involving both the maxilla and mandible. Postoperatively, she developed recurrent epistaxis that was difficult to control. Dynamic contrast-enhanced computed tomography and angiography were performed to identify the source of bleeding and revealed a pseudoaneurysm that was treated successfully by endovascular embolization. The etiology of bleeding after orthognathic surgery, including pseudoaneurysm formation, remains incompletely understood. In this case, substantial posterior repositioning of the maxilla was performed. Although there is a suggestion of a correlation between the extent of repositioning of bone fragments and vascular injury, this association has yet to be confirmed by large-scale studies. Preoperative computed tomography in this case also demonstrated calcification in the carotid arteries, suggesting underlying arteriosclerosis. In orthopedic surgery involving the lower limbs, iatrogenic arterial injury occurs more often in patients with atherosclerosis, implicating arterial fragility as a contributing factor. Decreased arterial elasticity as a result of atherosclerosis may increase the risk of vascular injury during orthognathic procedures. Although no definitive association has been established between atherosclerosis and vascular complications such as pseudoaneurysm, preoperative imaging findings may provide valuable information when assessing risk factors for postoperative complications.</p>