Treacher Collins syndrome (mandibulofacial dysostosis) is a rare congenital anomaly whose more severe phenotypic variants can be recognized during prenatal 2D ultrasonographic examination. 3D/4D ultrasonographic imaging is an effective tool for detection of even the less striking features of the syndrome, such as downslanting palpebral fissures or macrostomia. We present a case of Treacher Collins syndrome of de novo origin in a fetus of a nonconsanguineous healthy couple. The fetus was diagnosed at 19 weeks, 1 day of pregnancy and the diagnosis subsequently confirmed by invasive genetic testing. The genetic etiology of Treacher Collins Syndrome, basic embryology, principal ultrasonographic features, the need of a multidisciplinary approach for diagnosis, and optimal case management are discussed.