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 positionMandible

M0: normal mandible
M1: small mandible and glenoid fossa with short ramus
M2: ramus short and abnormally shaped2A: glenoid fossa in anatomical acceptable position
2B: Temperomandibular joint inferiorly (TMJ), medially, anteriorly displaced, with severely hypoplastic condyleM3: Complete absence of ramus, glenoid fossa, and TMJEar

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 displacedFacial 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 affectedSoft 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.
Speech disorders or speech impairments are a type of communication disorder in which normal speech is disrupted. This can mean stuttering, lisps, etc. Someone who is unable to speak due to a speech disorder is considered mute. Speech is a complex process that requires precise timing, nerve and muscle control, and as a result is susceptible to impairments. Speech disorders affect roughly 11.5% of the US population, and may be caused by a stroke, an accident or birth defect. Classification
Classifying speech into normal and disordered is more problematic than it first seems. By strict classification, only 5% to 10% of the population has a completely normal manner of speaking (with respect to all parameters) and healthy voice; all others have one disorder or another. There are three different levels of classification when determining the magnitude and type of a speech disorder and the proper treatment or therapy:
Sounds the patient can produce
Phonemic – can be produced easily; used meaningfully and constructively
Phonetic – produced only upon request; not used consistently, meaningfully, or constructively; not used in connected speech
Stimulate sounds
Easily stimulated
Stimulate after demonstration and probing (i.e. with a tongue depressor)
Cannot produce the sound
Cannot be produced voluntarily
No production ever observed

Types of disorder
Apraxia of speech may result from stroke or progressive illness, and involves inconsistent production of speech sounds and rearranging of sounds in a word ("potato" may become "topato" and next "totapo"). Production of words becomes more difficult with effort, but common phrases may sometimes be spoken spontaneously without effort.