To the Editor, Superficial trigeminal nerve blocks are performed by injecting local anesthetic in close proximity to the three individual terminal superficial branches of the trigeminal nerve divisions; i.e., supraorbital (of ophthalmic nerve; V1 division), infraorbital (of maxillary nerve; V2 division), and mental (sensory terminal branch of mandibular nerve; V3 division). Each nerve is anatomically close to its respective foramen (Fig. 1); thus nerve localization for this block ideally relies on a landmark-based approach using palpation of the foramina. However, occasionally it can be challenging to identify each foramen by relying on palpation alone. In these cases, many experts ‘‘search’’ for the foramina by gently probing with a small-gauge needle. Ultrasound (US) imaging is a safe simple non-invasive modality through which soft tissues and nerve structures can be visualized and identified when combined with a thorough knowledge of regional anatomy. However, there is limited information on the use of US for the identification of bony structures. Definitive identification of intraosseous landmarks, e.g., a tubercle, foramen, or notch around or through which the nerve travels, may be particularly important when, due to its small size and/or imaging artefacts, the target nerve of the block is unidentifiable with US. Sonographically, bone appears as a hyperechoic linear edge (white line) with an underlying anechoic (dark) shadow. Any disruption within the hyperechoic line may indicate either an anatomical defect or a discontinuity in the bone, such as a foramen. Using the above concept of discontinuity in the bone, we describe here a simple US-guided approach to locate the three important landmark foramina for superficial trigeminal nerve block. Using a high-frequency linear transducer (e.g., SLA 6–13 MHz 25 mm footprint hockeystick probe, MicroMaxx , Sonosite, Bothell, WA, USA), the foramina can be identified dynamically by subtle movement of the probe position after its placement in the usual vicinity of the foramina in order to capture the accompanying break in the linear hyperechogenicity of the bony surface.