The aim of this study is to an audit of the types, patterns, and indications for major oral and maxillofacial surgeries carried out at the Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital from January 2015 to December 2019. The findings from this study should provide valuable information to develop a future strategic plan, and improve clinical care. A retrospective review of the hospital records (including theatre logbooks, theatre lists, case notes and admission notebooks in the wards) of all patients operated upon within the study period was done. Descriptive statistics were used to analyze the collected data. Two hundred and forty-two (242) patients who had two hundred and eighty-eight (288) maxillofacial surgeries in the period under review formed the population for this study. There were 180 (62.5%) males and 108 (37.5%) females giving a male to female ratio of 1.6: 1. The ages observed ranged from 3 months to 85 years (median age of 23 years and mean age of 22.36 ± 20.09). Congenital/developmental conditions formed the largest indication for surgery, accounting for 113 (39.4%) of the cases seen. The most commonly performed surgery was cleft lip/palate repair (36.1%, n = 104), followed by mandibulectomy and reconstruction using plating systems (16.7%, n = 48). Major Oral and Maxillofacial surgeries are commonly carried out in our centre. The quality of service delivery can be improved upon through adequate manpower training in microvascular surgeries to help in better patient rehabilitation and provision of needed facilities.