Laryngeal clefts represent a congenital defect of the posterior larynx and esophagus in a small group of patients, with vast clinical presentation secondary to the degree of clefting present and other comorbid conditions. Previously, laryngeal clefts were all managed with open surgical techniques, but with advances in endoscopic instrumentation and techniques, there has been a shift toward endoscopic surgery. While a majority of type 1 and 2 laryngeal clefts can be managed exclusively via an endoscopic approach, type 3 and 4 laryngeal clefts may require an open surgical approach. The goal of open repair is to create a new esophageal and tracheal lumen with a two-layer closure in addition to placement of an interposition graft to avoid postoperative complications, predominantly dehiscence and/or fistulization. Common postoperative issues include granulation tissue and suture dehiscence which can be managed conservatively, but more severe complications such as tracheoesophageal fistula may require revision endoscopic or open surgery. More recent literature has discussed the complication of the inadequate glottis and posterior glottic stenosis, which often can be addressed primarily or secondarily by endoscopic approach with posterior grafting if necessary.