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An infant diagnosed with laryngomalacia failed to adequately improve on conservative management and developed recurrent aspiration symptoms. An ENT review revealed a bifid epiglottis and laryngeal cleft. The concurrent presence of both these rare conditions prompted a full body examination; digital anomalies were identified, and a clinical diagnosis of Pallister-Hall Syndrome was made. A barium swallow test confirmed aspiration. A trial of non-surgical interventions with paediatrics and speech therapy support yielded inadequate outcomes and the infant was taken to theatre for full airway evaluation, laryngeal cleft closure and partial supraglottoplasty. Post-operative progress showed resolution of aspiration + adequate weight gain.