Study Design Review of the literature with report of Case. Objective To review the presentation of Actinomycosis specifically as it occurs with mandibular osteotomies. Methods A review of the literature and report of an additional case. Results While minor infections secondary to local factors are usually seen 2–3 weeks after surgery, late infections are rare. Host factors may play a role. When actinomycosis is diagnosed, long-term antibiotics are necessary. Conclusions Actinomycosis is very rare following orthognathic surgery. It usually occurs in the mandible and following a sagittal split. Time of presentation for actinomycosis can vary from 6 weeks to 4 months as in our case. Infections occurring this late after surgery should be treated with suspicion of actinomycosis obtaining both cultures and tissue biopsies. Treatment involves an incision and drainage and long-term antibiotics.