At times, radical neck dissection may necessitate the sacrifice of bilateral internal jugular veins due to extensive nodal disease. This can lead to serious consequences such as the risk of blindness, potentially catastrophic laryngeal edema, stroke, and even death if the internal jugular vein (IJV) is absent or occluded. The reconstruction of the IJV presents an opportunity to mitigate these risks and their subsequent effects, whether performed during or after the neck dissection. The external jugular vein is commonly utilized for anastomosis when reconstructing the IJV, but its availability may be limited at times, prompting the consideration of alternative options. We present the case of a 50-year-old male patient with supraglottic malignancy (cT2N1M0), who had previously undergone chemo-radiotherapy. After a disease-free interval of 9 months, the patient experienced a nodal recurrence at bilateral level III. Subsequently, he underwent bilateral lateral neck dissection, involving the sacrifice of bilateral internal jugular veins due to extensive extranodal spread. The left-sided internal jugular vein was re-anastomosed using a right cephalic vein interposition graft. During the last follow-up, the disease was locoregionally controlled, with no observed neck lymphedema, and the patient maintained a functional larynx with good speech and swallow. Internal jugular vein re-anastomosis with a cephalic vein interposition graft proves to be a viable alternative in cases involving bilateral IJV ligation.