Mutations in the main genes responsible for TCS can be detected with chorionic villus sampling or amniocentesis. Rare mutations may not be detected by these methods. Ultrasonography can be used to detect craniofacial abnormalities later in pregnancy, but may not detect milder cases. Clinical findings TCS is often first suspected with characteristic symptoms observed during a physical exam. However, the clinical presentation of TCS can resemble other diseases, making diagnosis difficult. The OMENS classification was developed as a comprehensive and stage-based approach to differentiate the diseases. This acronym describes five distinct dysmorphic manifestations, namely orbital asymmetry, mandibular hypoplasia, auricular deformity, nerve development, and soft-tissue disease. Orbital symmetry O0: normal orbital size, position O1: abnormal orbital size O2: abnormal orbital position O3: abnormal orbital size and position Mandible M0: normal mandible M1: small mandible and glenoid fossa with short ramus M2: ramus short and abnormally shaped 2A: glenoid fossa in anatomical acceptable position 2B: Temperomandibular joint inferiorly (TMJ), medially, anteriorly displaced, with severely hypoplastic condyle M3: Complete absence of ramus, glenoid fossa, and TMJ Ear E0: normal ear E1: Minor hypoplasia and cupping with all structures present E2: Absence of external auditory canal with variable hypoplasia of the auricle E3: Malposition of the lobule with absent auricle, lobular remnant usually inferior anteriorly displaced Facial nerve N0: No facial nerve involvement N1: Upper facial nerve involvement (temporal or zygomatic branches) N2: Lower facial nerve involvement (buccal, mandibular or cervical) N3: All branches affected Soft tissue S0: No soft tissue or muscle deficiency S1: Minimal tissue or muscle deficiency S2: Moderate tissue or muscle deficiency S3: Severe tissue or muscle deficiency Radiographs A few techniques are used to confirm the diagnosis in TCS. An orthopantomogram (OPG) is a panoramic dental X-ray of the upper and lower jaw. It shows a two-dimensional image from ear to ear. Particularly, OPG facilitates an accurate postoperative follow-up and monitoring of bone growth under a mono- or double-distractor treatment. Thereby, some TCS features could be seen on OPG, but better techniques are used to include the whole spectrum of TCS abnormalities instead of showing only the jaw abnormalities. Another method of radiographic evaluation is taking an X-ray image of the whole head. The lateral cephalometric radiograph in TCS shows hypoplasia of the facial bones, like the malar bone, mandible, and the mastoid. Finally, occipitomental radiographs are used to detect hypoplasia or discontinuity of the zygomatic arch. CT scan