Chronic aspiration can be a life-threatening disorder of variable etiology. Often patients, both pediatric and adult, have suffered neurological devastation placing them at an increased risk of morbidity and mortality from laryngeal incompetence and the inability to protect their airways from soilage. Numerous surgical procedures have been described to tackle this problem; however, most definitive procedures cause damage to the intrinsic integrity of the larynx and are irreversible. Laryngotracheal separation with and without diversion is a definitive treatment option for intractable aspiration, that is, technically simple whereas still preserving the larynx for the possibility of future reversal. It is effective with a low complication profile. This article would address the indications, advantages, and surgical technique to laryngotracheal separation with or without diversion.