Congenital laryngotracheoesophageal cleft is a rare anomaly due to failure of fusion of the esophagus and the larynx, which presents a challenge to the anesthesiologists because of the potential problems of establishing and maintaining an airway. We could know that tracheal intubation does not guarantee a safe airway as there is the danger that the tube may slip through the cleft into the esophagus resulting in inability to maintain ventilation. We report a case of a one-month-old baby with a type III laryngotracheoesophageal cleft and review the literature on different ways of managing the airway.