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Diagram neck glands. Cervical Lymph Nodes: Anatomy, Function, and Clinical Significance

What are the main groups of cervical lymph nodes. How do cervical lymph nodes drain lymph from the head and neck. Why are cervical lymph nodes important in clinical practice. What is the anatomical distribution of cervical lymph nodes. How do cervical lymph nodes relate to the lymphatic system. What are the key functions of cervical lymph nodes. How can abnormalities in cervical lymph nodes indicate underlying disease.

Anatomical Overview of Cervical Lymph Nodes

The cervical lymph nodes, also known as the lymph nodes of the neck, comprise a complex network of lymphatic structures crucial for immune function and fluid balance in the head and neck region. These nodes are strategically positioned throughout the neck and can be classified into several distinct groups based on their anatomical location and drainage patterns.

Main Groups of Cervical Lymph Nodes

  • Superficial anterior cervical lymph nodes
  • Deep anterior cervical lymph nodes
  • Superficial lateral cervical lymph nodes
  • Deep lateral cervical lymph nodes
  • Accessory lymph nodes
  • Supraclavicular lymph nodes
  • Retropharyngeal lymph nodes

Understanding the anatomical distribution and relationships of these lymph node groups is essential for medical professionals, particularly in the fields of otolaryngology, oncology, and head and neck surgery.

Detailed Analysis of Cervical Lymph Node Groups

Superficial Anterior Cervical Lymph Nodes

Located adjacent to the anterior jugular vein, these nodes play a crucial role in draining lymph from the infrahyoid region, isthmus of the thyroid gland, and inferior larynx. From here, lymph is directed to the deep lateral cervical lymph nodes.

Deep Anterior Cervical Lymph Nodes

Situated primarily in the midline of the neck, these nodes can be further subdivided into four groups:

  1. Prelaryngeal nodes
  2. Thyroid nodes
  3. Paratracheal nodes
  4. Pretracheal nodes

These nodes are responsible for draining lymph from the larynx, trachea, and thyroid gland before directing it to the deep lateral cervical lymph nodes.

Superficial Lateral Cervical Lymph Nodes

Found adjacent to the external jugular vein, these nodes serve as a conduit for lymph drainage from the parotid nodes to the supraclavicular nodes.

Deep Lateral Cervical Lymph Nodes

This group of nodes, situated alongside the internal jugular vein, can be divided into superior and inferior subgroups. They are of paramount importance as they receive the majority of lymph from the head and neck region, ultimately draining into the jugular trunk.

Functional Significance of Cervical Lymph Nodes

The cervical lymph nodes play a vital role in the body’s immune defense and fluid balance mechanisms. Their primary functions include:

  • Filtering lymph fluid to trap pathogens and foreign particles
  • Hosting immune cells that initiate and coordinate immune responses
  • Facilitating the transport of lymph from surrounding tissues back into the bloodstream
  • Serving as sentinel nodes for detecting early signs of infection or malignancy in the head and neck region

These functions make cervical lymph nodes critical indicators of various pathological conditions affecting the head and neck area.

Lymphatic Drainage Patterns of Cervical Lymph Nodes

Understanding the lymphatic drainage patterns of cervical lymph nodes is crucial for diagnosing and treating various head and neck conditions. The general pattern of lymphatic drainage in the cervical region follows a predictable course:

  1. Lymph from superficial structures drains to superficial nodes
  2. Superficial nodes then drain to deeper node groups
  3. Deep nodes ultimately drain into the jugular lymphatic trunk
  4. The jugular trunk joins either the thoracic duct (on the left side) or empties directly into the internal jugular or brachiocephalic vein (on the right side)

This intricate drainage system ensures that lymph from all regions of the head and neck is efficiently processed and returned to the circulatory system.

Clinical Relevance of Cervical Lymph Nodes

The cervical lymph nodes hold significant clinical importance in various medical specialties. Their examination and assessment can provide valuable insights into a patient’s health status and potential underlying conditions.

Diagnostic Value

Enlarged or abnormal cervical lymph nodes can be indicative of various pathological processes, including:

  • Infections (bacterial, viral, or fungal)
  • Malignancies (primary or metastatic)
  • Autoimmune disorders
  • Lymphoproliferative disorders

Physical examination, imaging studies, and sometimes biopsy of these nodes can provide crucial diagnostic information.

Oncological Significance

In head and neck cancers, the status of cervical lymph nodes is a critical prognostic factor. The presence or absence of nodal metastases significantly influences treatment planning and overall patient outcomes.

Imaging Techniques for Cervical Lymph Node Assessment

Several imaging modalities are employed to evaluate cervical lymph nodes, each offering unique advantages:

  • Ultrasonography: Offers real-time, non-invasive assessment and can guide fine-needle aspiration biopsies
  • Computed Tomography (CT): Provides detailed cross-sectional images, useful for staging and treatment planning
  • Magnetic Resonance Imaging (MRI): Offers superior soft tissue contrast, beneficial for assessing nodal architecture and extracapsular spread
  • Positron Emission Tomography (PET): Allows functional imaging to detect metabolically active nodes, particularly useful in oncology

The choice of imaging modality depends on the clinical context, suspected pathology, and available resources.

Surgical Considerations in Cervical Lymph Node Management

Surgical management of cervical lymph nodes is a critical aspect of head and neck oncology. The extent of lymph node dissection depends on various factors, including the primary tumor site, stage, and patient-specific considerations.

Types of Neck Dissections

  1. Radical Neck Dissection: Removal of all lymph node groups from levels I to V, along with the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve
  2. Modified Radical Neck Dissection: Preserves one or more non-lymphatic structures
  3. Selective Neck Dissection: Removes specific lymph node groups based on the predicted pattern of metastasis
  4. Extended Neck Dissection: Includes additional lymph node groups or structures not typically removed in a radical neck dissection

The choice of neck dissection technique is tailored to balance oncological control with functional preservation and quality of life considerations.

Emerging Research and Future Directions

The field of cervical lymph node research is continuously evolving, with several exciting areas of investigation:

  • Sentinel Lymph Node Biopsy: Refinement of techniques to identify and selectively sample the first draining lymph node, potentially reducing the need for extensive neck dissections
  • Immunotherapy: Development of targeted therapies to enhance the immune response within cervical lymph nodes against cancer cells
  • Advanced Imaging: Integration of artificial intelligence and machine learning algorithms to improve the accuracy of lymph node assessment in imaging studies
  • Molecular Profiling: Utilization of genomic and proteomic analyses of lymph node tissue to guide personalized treatment strategies

These advancements promise to enhance our understanding of cervical lymph node biology and improve patient outcomes in various head and neck pathologies.

The cervical lymph nodes represent a complex and crucial component of the head and neck anatomy. Their intricate arrangement, diverse functions, and clinical significance underscore the importance of a thorough understanding for medical professionals across various specialties. As research continues to unravel the intricacies of these structures, we can anticipate more refined diagnostic and therapeutic approaches in the management of head and neck disorders.

Cervical lymph nodes: anatomy, groups and drainage

Author:
Roberto Grujičić MD

Reviewer:
Dimitrios Mytilinaios MD, PhD

Last reviewed: December 05, 2022

Reading time: 3 minutes

Superficial anterior cervical lymph nodes

Nodi lymphoidei cervicales anteriores superficiales

1/7

Synonyms:
Nodi lymphatici cervicales anteriores superficiales, Lymphonodi cervicales anteriores superficiales


The cervical lymph nodes, commonly known as the lymph nodes of the neck, are a large group of lymph nodes that can be classified into several groups. These groups of nodes include:

  • The superficial anterior cervical lymph nodes that are situated adjacent to the anterior jugular vein. These nodes drain lymph from the infrahyoid region, isthmus of the thyroid gland, inferior larynx to the deep lateral cervical lymph nodes.
  • The deep anterior cervical lymph nodes that are situated mostly in the midline and can be divided into four groups of nodes including the prelaryngeal, thyroid, paratracheal and pretracheal nodes. They drain lymph from the larynx, trachea, and thyroid to the deep lateral cervical lymph nodes. 
  • The superficial lateral cervical lymph nodes that are situated adjacent to the external jugular vein. They drain lymph from the parotid nodes to the supraclavicular nodes. 
  • The deep lateral cervical lymph nodes that are situated adjacent to the internal jugular vein. They can be subdivided into superior and inferior groups. These nodes receive the majority of lymph from the head and neck region and drain to the jugular trunk. 
  • The accessory lymph nodes that are the most lateral group of cervical nodes, located adjacent to the accessory nerve. These nodes drain lymph from the lateral neck, pharynx and shoulder regions and empty into the supraclavicular nodes.
  • The supraclavicular lymph nodes that are situated at the root of the neck. These nodes receive lymph from the deep lateral cervical lymphatic vessels and empty into the jugular trunk on each side. 
  • The retropharyngeal lymph nodes that are situated posterior to the pharynx. These nodes receive afferents from the nasal cavities, paranasal sinuses, soft palate, palatine arch, outer and middle ear and drain into the superior and inferior deep lateral cervical lymph nodes of the neck.


In summary, all lymphatic vessels from the head and neck drain directly or indirectly into the deep cervical lymph nodes. Lymph from these deep nodes passes to the jugular lymphatic trunk, which joins the thoracic duct on the left side and the internal jugular vein or brachiocephalic vein on the right side.





Terminology

English: Cervical lymph nodes
English synonym
: Lymph nodes of the neck
Latin
: Nodi lymphoidei cervicales
Latin synonyms:
Nodi lymphatici cervicales, Lymphonodi cervicales

Main groups

Superficial anterior cervical lymph nodes
Deep anterior cervical lymph nodes
Superficial lateral cervical lymph nodes
Deep lateral cervical lymph nodes
Accessory lymph nodes
Supraclavicular lymph nodes
Retropharyngeal lymph nodes

Function

Lymph nodes of the neck filter and transport lymph from surrounding lymph nodes and viscera back into the bloodstream

Test your knowledge on the lymphatics of the head and neck with this quiz.


Learn all about the lymph nodes of the head and neck with the following study unit: 

Lymphatics of the head and neck

Explore study unit



All content published on Kenhub is reviewed by medical and anatomy experts. The information we provide is grounded on academic literature and peer-reviewed research. Kenhub does not provide medical advice. You can learn more about our content creation and review standards by reading our content quality guidelines.

  • Lambert SM. Shoulder girdle and arm. In: Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Elsevier; 2016. p. 834.
  • Richter E, Feyerabend T. Normal lymph node topography: CT atlas. Springer; 2004.
  • Iwanaga J, Lofton C, He P, Dumont AS, Tubbs RS. Lymphatic System of the Head and Neck. J. Craniofac. Surg. 2021;32(5):1901–5.

  • Kyriacou H, Khan YS. Anatomy, Shoulder and Upper Limb, Axillary Lymph Nodes. StatPearls. 2021;

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Anatomy and Pathology: Cervical Lymph Nodes

Lymph nodes are small bean-shaped structures that constitute a major part of the body’s immune system [1, 2]. Lymph nodes filter substances that travel through the lymph fluid, and contain lymphocytes (white blood cells) that help the body fight infection and disease. There are hundreds of lymph nodes found throughout the body [1, 3]. They are connected to one another by lymph vessels. Clusters of lymph nodes are found in the neck, axilla (underarm), chest, abdomen, and groin [1–4].

6.1.1 Basic Anatomy

Normal lymph nodes are small anatomical oval or kidney-shaped structures with a size ranging from 0.1 to 2.5 cm in size. They are surrounded by a thick connective tissue capsule extending with diaphragms inside the lymph nodes covering multiple compartments [1, 3].

The parenchyma of the lymph nodes is distinguished in the cortical, subcortical, and medullary sections. Enclosed areas of the cortical section form the primary follicles containing a large number of B- and T lymphocytes, mononuclear, and macrophages. B lymphocytes produce antibodies, T lymphocytes destroy antigens, and macrophages perform phagocytosis [1, 3, 4].

A small opening in the middle of the glands creates an area rich in fibrous and fatty tissue designated as the hilum. The medullary section surrounds the hilum and is separated from the cortical section by insertion of the transitional zone of the subcortex. The blood supplying artery enters through the hilum and the corresponding vein and the lymph nodes exit through it [1–4].

The accessory lymph nodes collect the lymph from the adjacent tissues and centrally discharge into the capsule of the lymph nodes. The transported lymph infiltrates the lymph nodes, which act as “refineries” of blood, destroying germs, viruses, cancer cells, and harmful foreign substances before eventually entering the venous circulation.

The lymph nodes are innervated by autonomic nervous system fibers and their innervation include the capsule, the inner diaphragms, and the smooth muscle of the blood vessels [1–4].

6.1.2 Regional and Functional Classification of Lymph Nodes

Based on the older and more recent historical data cervical lymph nodes are classified at least in six different anatomical levels (level I–VI) with different varying subclassifications aiming to the more accurate classification of the pathology, the more detailed surgical planning, and the better programming of the treatment of cervical and even head and neck cancer [5–7].

Figure 6.1 depicts a more current classification of the varying levels and anatomical borders that apply to daily clinical and radiographic treatments, which are analyzed in detail below.

Fig. 6.1

Classification of the neck regions based on lymph node groups. Courtesy of Aikaterini Spanou

The major lymph node groups of the head region are described together with their topographic location and the structures they drain [5–7].

So basically they are classified according to their drainage and the major divisions are:

  • Facial: Skin and mucosa of the eyelids, the nose, the buccal area, the temporal and subtemporal region, and rinopharynx

  • Parotid: Skin of the temporal and frontal region. The maxilla, the buccal area, the external acoustic meatus and eardrum, the eyelids, and section of the nose.

  • Retroauricular: Side section of the hairy part of the skin behind the ear, the skin at the external acoustic meatus region, and the external ear

  • Suboccipital: Posterior section of the hairy part of the head

Cervical lymph nodes are accepted as intermediary stations of the lymph drainage from the head and face lymph nodes groups. They also drain the soft tissues of the region and the organs that are present in the neck area [5, 8, 9]. The most important groups are:

  • Submental: Lower lip, tongue tip, gums, and anterior teeth

  • Submandibular: Upper and lower lip, intraoral mucosa, tongue, mandible gums, and teeth

  • Jugulodigastric: Lingual and pharyngeal tonsils, hard palate, sections of the tongue

  • Deep cervical: Larynx, trachea, thyroid gland, parathyroid glands, and upper esophagus

  • Supraclavicular: Anterior thoracic wall, armpit region, shoulder, and upper limb

  • Superficial cervical lymph nodes are lying on the surface of the sternocleidomastoid muscle, they drain the skin, and the superficial tissues and flow into the deep cervical lymph nodes.

When one is talking about varying levels of classifications, the most frequently followed divisions of the cervical lymph nodes are those according to the American Academy of Otolaryngology which classifies them as follows:

Level I: Submental and submandibular nodes

  • Level Ia: Submental, within the triangular boundary of the anterior belly digastric muscles and the hyoid bone.

  • Level Ib: Submandibular triangle—within the boundaries of the anterior belly of the digastric muscle, the stylohyoid muscle, and the body of the mandible.

Level II: Upper jugular nodes (Subdigastric nodes)—around the upper third of the internal jugular vein and adjacent accessory nerve. The upper boundary is the base of the skull and the lower boundary is the inferior border of the hyoid bone. The anterior/medial boundary is the stylohyoid muscle and the posterior/lateral one is the posterior border of the sternocleidomast​oid muscle. On imaging, the anterior/medial boundary is the vertical plane of the posterior surface of the submandibular gland.

Level III: Middle jugular nodes—around the middle third of the internal jugular vein, from the inferior border of the hyoid to the inferior border of the cricoid cartilage. Anteromedially they are bounded by the lateral border of the sternohyoid muscle and posterolaterally by the posterior border of the sternocleidomastoid.

Level IV: Lower jugular nodes—around the lower third of the internal jugular vein from the inferior border of the cricoid to the clavicle, anteromedially by the lateral border of the sternohyoid and posterolaterally by the posterior border of the sternocleidomastoid.

Level V: Posterior triangle nodes—around the lower half of the spinal accessory nerve and the transverse cervical artery, and includes the supraclavicular nodes. The upper boundary is the apex formed by the convergence of the sternocleidomastoid and trapezius muscles, and inferiorly by the clavicle. The anteromedial border is the posterior border of the sternocleidomastoid and the posterolateral border is the anterior border of the trapezius.

  • Level VA: Above the horizontal plane formed by the inferior border of the anterior cricoid arch, including the spinal accessory nodes.

  • Level VB: Lymph nodes below this plane, including the transverse cervical nodes and supraclavicular nodes (except Virchow’s node which is in IV).

Level VI: Anterior compartment nodes—Pretracheal, paratracheal, precricoid (Delphian), and perithyroid nodes, including those on the recurrent laryngeal nerve. The upper border is the hyoid, the lower the suprasternal notch, and the lateral borders the common carotid arteries

The American Joint Committee on Cancer (AJCC) system differs from the above by including Level VII, which is based on the 2002 American Academy system, although the boundaries are defined slightly different [5]

The boundaries are defined as (Superior, Inferior, Anteromedial, Posterolateral)

  • Level IA: Symphysis of mandible, Body of hyoid, Anterior belly of the contralateral digastric muscle, Anterior belly of ipsilateral digastric muscle

  • Level IB: Body of mandible, Posterior belly of digastric muscle, Anterior belly of digastric muscle, Stylohyoid muscle

  • Level IIA: Skull base, Horizontal plane defined by the inferior border of the hyoid bone, The stylohyoid muscle, Vertical plane defined by the spinal accessory nerve

  • Level IIB: Skull base, Horizontal plane defined by the inferior body of the hyoid bone, Vertical plane defined by the spinal accessory nerve, Lateral border of the sternocleidomastoid muscle

  • Level III: Horizontal plane defined by the inferior body of hyoid, Horizontal plane defined by the inferior border of the cricoid cartilage, Lateral border of the sternohyoid muscle, Lateral border of the sternocleidomastoid or sensory branches of cervical plexus

  • Level IV: Horizontal plane defined by the inferior border of the cricoid cartilage, Clavicle, Lateral border of the sternohyoid muscle, Lateral border of the sternocleidomastoid, or sensory branches of cervical plexus

  • Level VA: Apex of the convergence of the sternocleidomastoid and trapezius muscles, Horizontal plane defined by the lower border of the cricoid cartilage, Posterior border of the sternocleidomastoid muscle or sensory branches of cervical plexus, Anterior border of the trapezius muscle

  • Level VB: Horizontal plane defined by the lower border of the cricoid cartilage, Clavicle, Posterior border of the sternocleidomastoid muscle, Anterior border of the trapezius muscle

  • Level VI: Hyoid bone, Suprasternal notch, Common carotid artery

  • Level VII: Suprasternal notch, Innominate artery, Sternum, Trachea, esophagus, and prevertebral fascia

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Pitster fork seal replacement instructions with photo

Nothing new. All according to the standard scheme.
We take a pen, and unscrew the top cork. Drain the oil through it, if you have any left there at all.

Now we unscrew the nut itself from the stem, on this fork it must be done, this is not for you, where it is enough just to remove the lower glasses.

By unscrewing the plug, the springs are fully accessible and can be easily removed in order to subsequently wash off old oil and dirt.

Next, turn the nib over, and prying off the boot, lift it up along the nib. It is advisable to do this carefully, because if the fork is not killed to death, the anthers can be used again, you just need to wash them well by cleaning out the sand and other dirt, and treat them with silicone.

By lifting the boot you have access to the retaining ring, which you can get with a special tool, otherwise there is a risk of scratching the pen mirror if you climb into it with screwdrivers.

It remains only to get the oil seal. To do this, as with any gland, we heat its seat, and in our case, we cut the pen in a circle with a building hair dryer in the area of ​​\u200b\u200bthe gland. BUT WITHOUT FANATISM! This is because if you don’t care about the old oil seal, then here’s the plastic ring, which is hardly under it.
As soon as everything is warmed up, carefully, according to the principle of a reverse hammer, we knock out a pen from a glass along with an oil seal and guides.

As you can see, we have a pen guide on top, which will need to be removed in order to dismantle the pen guide, plastic washer and oil seal.

All removed elements must be thoroughly washed, except for the oil seal, of course, because they are to be replaced.
Let’s assume that you have washed everything, all small elements, feathers, glasses, springs and so on.

We collect everything on the pen in the reverse order: dust boot, retaining ring, oil seal, plastic ring, cup guide, and the guide that is put on the pen.

To install the glass guide and the gland, again, you need to warm up the seats well with a hair dryer, if you do everything right, the guide will rise without effort, but you can help it with a thin wooden knob.

Completely forgot. The seats before installation, and the parts themselves, must be well lubricated with engine oil, for an easier and smoother fit, or use a special lubricating paste that comes with some types of oil seals.

This fork has a 33/46/10 oil seal, the last digit may vary. The last dimension is the height, so the last digit could be 10; 10.5; 11.

The stuffing box, if it is well lubricated and the seat is warmed up, should not stand up without effort, but consider it to “fall” into the seat. If suddenly, for some unknown reason, the gland does not go, we use a special mandrel.
The most primitive mandrel for seating an oil seal can be made from a plastic thick-walled pipe, sawn in half lengthwise, which you simply help to seat the oil seal without much effort.
We are slowly finishing by installing the retaining ring and installing the anther in place. This is not at all difficult to do.

The whole assembly is finished, you only need to add oil until the plug is screwed onto the stem, it’s just more convenient.

Information on the amount of oil to be poured differs, I poured about 220 ml from a non-pierced feather, taking this into account, and the fact that there is still oil on all working parts of the fork, I poured 250 ml into each feather.
Well, everything actually.
We screw the nut onto the stem, lock it with the bottom nut, and tighten it. DONE)

Complete disassembly and assembly of the fork with the replacement of oil seals

So, this article will be entirely devoted to disassembly, replacement of oil seals and assembly of the front fork.

For disassembly we need:

1 hexagon 5 mm

2 hexagon 8mm

3 two keys 17 mm

4 key 14 mm

5 circlip pliers

6 hair dryer (REQUIRED)

7 key for 12 mm

8 key for 8 mm

9 flat screwdriver

First remove the front wheel and unscrew the front caliper.

We also unscrew the protection of the feathers of the fork.

Now that the stays are free of attachments, loosen the crossheads and remove the fork stays.

Now that the feathers are in your hands, unscrew the bolt holding the cups of the front axle with a hexagon.

After that, we can unscrew the top plug of the pen and drain the old oil. After that, we can proceed to direct disassembly.

So, we take out the springs, namely the springs, because it is not a single one, but consists of 3 components with a spacer between each section, and, most importantly, we can remove the outer glass, in which our eternally flowing native oil seals are located, the quality of which causes gray hair . For example, my oil seals leaked after I simply changed my native “sunflower” oil to normal, while the pit just stood motionless in the apartment, and one fine day. If you are very lazy, then it is enough to unscrew the plug and remove the springs is not necessary, but I am not an adherent of collective farm repair, and if you do, then do it, carefully washing every detail of the mechanism.

Now, carefully, without dope, so as not to scratch the glass, pry off the boot with a screwdriver and remove it, after that we have access to the retaining ring holding the stuffing box, and take it out with special tongs.

Naturally, many crooked individuals will climb to pick the retaining ring with screwdrivers, nails, etc. GO GUYS!!! Scratch the seal seats and you will come to success in the form of replacing the entire fork.

My fork already had the oil seal removed, so don’t worry, I’m showing it to you.

So, if all this is done, you can start dismantling the gland, but it sits quite tightly and deeply, again, you will try to tear it out of there with screwdrivers . .. the result has already been described above.

Do you want to do it right? Then we take a building hair dryer and heat the place where the stuffing box is planted in a circle, so that the metal expands from heating and releases pressure on the stuffing box (physics grade 5 :)).

Warm up to 150-200 degrees. And only after that, for the INSIDE part of the stuffing box, you can pry it, if everything is done correctly, it will be in your hands.

A fully disassembled fork looks like this, and this is the order in which all parts should follow each other.

Now that the entire fork has been disassembled, washed and cleaned of all Chinese rubbish, we go directly to the oil seals.

The dimension of oil seals is 33x45x10 / 10.5 , a fairly common dimension, so there should be no problems with the purchase.

Now about the manufacturer.

Want to put cheap Chinese flags in your teeth, but be prepared to change them once a month.

An excellent option are the oil seals presented in the photo, they are sold at the best price.

The seals come with a special grease that makes it easier to install the seal in the pen, in principle, you can use plain oil, but since the grease is included, why not use it for its intended purpose?

Before installation, carefully smear the inner outer part of the oil seal, and be sure to smear the seat in the pen.

Now we take my favorite building hair dryer and heat the seat to the same 150-200 degrees. (Better work with gloves, because when you plant the omentum in a fire pen, the chance of getting burned is 100% -)

When everything is well warmed up, insert a new omentum and immediately put the OLD omentum on top of it, it will serve as a frame for planting a new omentum.

WE DO ALL THIS EXCLUSIVELY BY HANDS!!!!!! NO HAMMERS!!!!!!!

But, unfortunately, no matter how hard you put pressure on the second oil seal, it is not enough for the new oil seal to reach the stop, and there is one small trick here :))

Everything is ingenious and simple! We take the plug of the plug and insert it into the old stuffing box.

We turn the glass over, resting the cork on the floor, and with effort, but without fanaticism, press on the pen, you can lightly tap on top with your palm.

Tadaaaaaaaam and the stuffing box fell into place until it stops)

Carefully pry off the old oil seal that we do not need with a screwdriver and return the retaining ring to its rightful place.

The final stage – we connect the feather and the glass together. Insert the pen into the glass very carefully and make sure that the gland cuff does not wrap, otherwise all the work done is wasted.

We have reached the finish line. We screw the pen plug onto the stem and lock it with a 14 mm nut.

It remains to fill in fork oil of 10 or 15 viscosity, each feather requires about 230 mm .

We put a glass on the pen, on which the axis is attached, while the glass needs to be treated with copper grease in order to avoid its further souring, lightly apply thread sealant to the mounting bolt.