is treated by bone conduction amplification, speech therapy, and educational intervention to avoid language/speech problems. the bone-anchored hearing aid is an alternative for individuals with ear anomalies. zygomatic and orbital reconstruction is performed when the cranio-orbitozygomatic bone is completely developed, usually at the age of 5–7 years. in children, an autologous bone graft is mostly used. in combination with this transplantation, lipofilling can be used in the periorbital area to get an optimal result of the reconstruction. reconstruction of the lower eyelid coloboma includes the use of a myocutaneous flap, which is elevated and in this manner closes the eyelid defect. external ear reconstruction is usually done when the individual is at least eight years old. sometimes, the external auditory canal or middle ear can also be treated. the optimal age for the maxillomandibular reconstruction is controversial; as of 2004, this classification has been used: type i (mild) and type iia (moderate) 13–16 years type iib (moderate to severe malformation) at skeletal maturity type iii (severe) 6–10 years when the teeth are cutting, the teeth should be under supervision of an orthodontist to make sure no abnormalities occur. if abnormalities like dislocation or an overgrowth of teeth are seen, appropriate action can be undertaken as soon as possible. orthognathic treatments usually take place after the age of 16 years; at this point, all teeth are in place and the jaw and dentition are mature. whenever osas is detected, the level of obstruction is determined through endoscopy of the upper airways. mandibular advancement can be an effective way to improve both breathing and æsthetics, while a genioplasty only restores the profile. if a nose reconstruction is necessary, it is usually performed after the orthognathic surgery and after the age of 18 years. the contour of the facial soft tissues generally requires correction at a later age, because of the facial skeletal maturity. the use of microsurgical methods, like the free flap transfer, has improved the correction of facial soft tissue contours. another technique to improve the facial soft tissue contours is lipofilling. for instance, lipofilling is used to reconstruct the eyelids. hearing loss hearing loss in treacher collins syndrome is caused by deformed structures in the outer and middle ear. the hearing loss is generally bilateral with a conductive loss of about 50–70 db. even in cases with normal auricles and open external auditory canals, the ossicular chain is often malformed. attempts to surgically reconstruct the external auditory canal and improve hearing in children with tcs have not yielded positive results. auditory rehabilitation with bone-anchored hearing aids (bahas) or a conventional bone conduction aid has proven preferable to surgical reconstruction. psychiatric the disorder can be associated with a number of psychological symptoms, including anxiety, depression, social phobia, and distress about body image. people who have this disorder may also experience discrimination, bullying, and name calling, especially when young. a multi-disciplinary team and parental support should include these issues. epidemiology tcs occurs in about one in 50,000 births in europe. worldwide, it is estimated to occur in one in 10,000 to one in 50,000 births. history the syndrome is named after edward treacher collins (1862–1932), the english surgeon and ophthalmologist who described its essential traits in 1900. in 1949, adolphe franceschetti and david klein described the same condition on their own observations as mandibulofacial dysostosis. the term mandibulofacial dysostosis is used to describe the clinical features. culture in july 1977, a new york times article describing new plastic surgery techniques which could partially correct the appearance of those with treacher collins syndrome was widely circulated resulting in raised awareness of the disease. prior to beginning his comedy career, bob saget made a documentary short called "through adam's eyes" documenting his young nephew's experiences undergoing facial reconstructive surgery due to treacher collins; the film won a student academy award. the disorder was featured on the show nip/tuck, in the episode "blu mondae". tlc's born without a face features juliana wetmore, who was born with the most severe case in medical history of this syndrome and is missing 30%–40% of the bones in her face. in 2010, bbc three documentary love me, love my face covered the case of a man, jono lancaster, with the condition. in 2011, bbc three returned to jono to cover his and his partner laura's quest to start a family, in so what if my baby is born like me?, which first aired as part of a bbc three season of programmes on parenting. the first film was replayed on bbc one shortly ahead of the second film's initial bbc three broadcast. lancaster's third bbc three film, finding my family on facebook, which looked at adoption, aired in 2011. in wonder, a children's novel, the main character is a child who has treacher collins syndrome. a 2017 film adaptation of wonder, starring julia roberts, owen wilson and jacob tremblay, was released in november 2017. alison midstokke, who appears in the drama film happy face (2018), is an actress and activist who has the condition.