Intraoral vertico-sagittal ramus osteotomy is a suitable osteotomy for correction of mandibular prognathism and small retrognathism, associated with predictable results. Although few complications have been described when this technique is used, the Oral and Maxillofacial Surgeon must be prepared to manage them when they occur. The purpose of this presentation is to point the most common problems and the decisions we have been taking in our 15 years experience doing this osteotomy.