The patient with Crohn's disease poses an interesting challenge to the oral and maxillofacial surgeon contemplating orthognathic surgery. Elective surgery should be limited to periods of disease remission. Even in a quiescent state, however, this disease requires careful perioperative management. Special attention must be paid to the patient's diet and maintenance medications. Often these patients have required long-term corticosteroid therapy, which, in addition to increasing surgical and anesthetic risk, has the potential to adversely affect bone healing. This article presents a review of the pathophysiology of Crohn's disease and discusses the perioperative and postoperative concerns associated with this disease.