Oral and maxillofacial surgeons offer their patients a wide variety of surgical options that may be classified as major or minor surgery. Complications are part of surgery, but major surgery may lead to life-threatening complications that must be managed by the surgical team. Obtaining iliac graft tissue during oral and maxillofacial reconstruction carries the risk of rare but serious complications, such as deep vein thrombosis and fat embolism syndrome. In this paper we describe the latter postoperative complication experienced by a patient undergoing an otherwise routine major oral and maxillofacial reconstructive procedure. A discussion of the factors that stimulate fat embolism during or following surgical procedures is intended to help surgeons prevent this complication.