Roentgencephalometric analysis of cerebral gigantism: report of four patients.

Roentgencephalometric investigation of four patients (three male, one female) with cerebral gigantism (Soto syndrome) demonstrated that both the neurocranium and facial skeleton are increased in size. The recessed flat facies characteristic of the syndrome can be attributed to the increased anterior cranial base length and frontal bossing combined with relative retroposition of the maxilla. Mandibular body length was increased but ramal height was within normal limits. The obtuse gonial angle added to the effective length of the mandible. The backward rotation of the mandible resulting from the obtuse gonial angle contributed to increased lower face height.