The Paun Maneuver: An Intraoperative Pull Test to Verify Septal Fixation to the Anterior Nasal Spine

Background: Secure fixation of the caudal septum to the anterior nasal spine (ANS) is critical for stable rhinoplasty outcomes. However, there is no standardized method for intraoperative verification of suture engagement in the ANS periosteum, creating a potential for fixation instability Case Presentation: We present a representative surgical case to illustrate the “Paun Maneuver,” a novel intraoperative pull test. During an open rhinoplasty procedure for nasal framework reconstruction, a 3-0 polydioxanone (PDS) cutting suture was passed deep into the periosteum of the ANS. Before securing the suture, the maneuver was performed by applying firm anterior traction to both suture ends. The resulting immobility of the entire head–nose complex provided immediate tactile confirmation of a secure and deep periosteal bite. Following this successful verification, the posterior septal angle was definitively anchored to the ANS using a horizontal mattress configuration. The procedure was completed without complications, ensuring a stable foundation for subsequent tip reconstruction. Conclusion: The Paun Maneuver is a simple, rapid, and reproducible technique that addresses a critical gap in septal fixation. By providing real-time, tactile verification of secure periosteal anchoring, it ensures confidence in surgery and reduces the risk of unrecognized fixation failure, thereby contributing to more predictable and durable rhinoplasty outcomes