During history-taking for sialadenitis, which physical examination finding may be observed?

• A. Tenderness at the duct opening with pus if duct massaged
• B. Painless swelling
• C. Bruising of cheek
• D. Hearing loss

Answer: (A)

In acute bacterial sialadenitis, a key physical finding is tenderness at the duct opening with purulent discharge that can be expressed by milking the duct. This happens because infection and inflammation involve the ductal system, so pressing or milking the duct may release pus from the Stensen or Wharton ducts. The combination of pain localized to the gland or duct and visible or expressible purulent material is highly suggestive of an infectious process rather than simple swelling from noninfectious causes. Painless swelling would be less typical once infection has set in, bruising of the cheek is not a usual sign of salivary gland infection, and hearing loss is not a typical feature of sialadenitis.