Hypopharyngeal perforations in the neonate have rarely been reported, although such a disorder may be a more common occurrence than suspected. The optimal therapy is controversial. A case is presented in which instrumentation of the upper airway led to a transmural hypopharyngeal perforation in a naonate. The infant did well with conservative therapy. The early recognition of hypopharyngeal lacerations is of great importance. When the correct diagnosis is made, the condition of infants with pseudodiverticulum of the hypopharynx can be managed successfully without surgery.