Objective To explore the risk factors for postoperative moderate-to-severe complications (Clavien-Dindo grade ≥Ⅱ) in patients with oral and maxillofacial malignant tumors. Methods Clinical data of 662 patients receiving surgical resection for oral and maxillofacial malignant tumors were retrospectively reviewed. Patients were categorized into the no/grade Ⅰ complication group and grade ≥Ⅱ complication group in accordance with the Clavien-Dindo grade of postoperative complications. Baseline characteristics were compared between groups. Binary Logistic analysis regression was performed to screen predictors of postoperative Clavien-Dindo grade ≥Ⅱ complications in patients with oral and maxillofacial malignant tumors. A nomogram prediction model was constructed incorporating independent risk factors. Receiver operating characteristic (ROC) curve and calibration curve were generated to assess the discriminative ability and calibration of the model. Results Among the 662 patients undergoing surgical treatment for malignant tumors of the oral and maxillofacial region, postoperative complications occurred in 355 cases (53.6%), and 268 cases (40.5%) presented with complications of Clavien-Dindo grade ≥Ⅱ. There were statistically significant differences between the no/grade Ⅰ complication group and grade ≥Ⅱ complication group in body mass index, hyperlipidemia, preoperative anemia, preoperative hyponatremia, intraoperative hypotension, operative duration and TNM stage (P<0.05). Logistic regression analysis revealed that body mass index <18.5 kg/m², hyperlipidemia, preoperative anemia, intraoperative hypotension, operative duration ≥240 min, and TNM stage Ⅲ were risk factors for postoperative Clavien-Dindo grade ≥Ⅱ complications in patients undergoing surgery for oral and maxillofacial malignant tumors (P<0.05). The nomogram model constructed based on these risk factors exhibited good discrimination, calibration and internal consistency for predicting postoperative Clavien-Dindo grade ≥Ⅱ complications in patients undergoing surgery for oral and maxillofacial malignant tumors. Conclusion Patients undergoing surgery for oral and maxillofacial malignant tumors have a relatively high incidence of postoperative complications. Body mass index <18.5 kg/m2, hyperlipidemia, preoperative anemia, intraoperative hypotension, operative duration ≥240 min, and TNM stage Ⅲ are risk factors for developing postoperative Clavien-Dindo grade ≥Ⅱ complications. The nomogram model constructed based on the above risk factors has good discrimination and calibration, with high clinical application value.