The posterior laryngeal cleft is a rare congenital anomaly which results from absence of fusion of the posterior cricoid lamina and possibly the tracheoesophageal septum. A high degree of suspicion is required for early diagnosis and repair to prevent significant morbidity and mortality from recurrent aspiration pneumonia. Minor clefts may be repaired endoscopically, whereas severe laryngotracheoesophageal clefts require a multidisciplinary approach with combined extrathoracic and intrathoracic repair. Associated congenital anomalies increase the mortality of the laryngeal clefts and may complicate the timing of surgical repair.