The pons is the diplomat of the brainstem. It connects, negotiates, and mediates. Anatomically named after the Latin word for bridge, it does exactly that – it links the brain to the body, movement to expression, wakefulness to sleep. If the midbrain watches, the pons communicates.
The pons is also deeply invested in your face. It governs blinking, smiling, chewing, tearing, and many of the expressions you assume are yours alone. When it misbehaves, it does not do so discreetly.
A middle-aged gentleman walked into my clinic with half his face staging a quiet protest. One eyebrow refused to rise. One eye would not close. His mouth tilted sideways, as if unsure of which direction to smile. He was impeccably dressed, with a trimmed moustache, but his hair was dishevelled. His wife sat beside him, concerned but perceptive. “Doctor,” she said, “he looks the same, but he doesn’t look like himself.”
He had woken up that morning unable to recognise his own reflection. Speech was slightly slurred. Water escaped the corner of his mouth. The diagnosis, thankfully, was not a stroke or tumour, but something far more common and far more unnerving: Bell’s palsy.
Bell’s palsy is named after Sir Charles Bell, the 19th-century Scottish anatomist who meticulously described the facial nerve and its functions. In an era without imaging, steroids, or Google, Bell managed to map facial paralysis with extraordinary insight. History, occasionally, gets it right.
The facial nerve’s journey is a long and perilous one. It emerges from the pons, travels through a narrow bony canal, and fans out across the face like a conductor directing expression. Any inflammation along this path can silence it temporarily. Viral reactivation, stress, immune responses – the exact cause remains conveniently vague, much like most things that matter.
Bell’s palsy is dramatic. It arrives overnight. Patients go to bed fine and wake up unrecognisable. The fear is immediate. Am I having a stroke? Will my face stay this way forever? Will people think I am winking at them deliberately? The pons, of course, remains unimpressed by panic. It simply waits.
Bell’s palsy, incidentally, has never discriminated between the famous and the forgettable. Julius Caesar is believed to have had episodes of facial weakness, although history remembers him more for crossing rivers than drooping eyebrows. George Clooney developed Bell’s palsy early in his career and recovered completely, going on to become a global ambassador for symmetrical smiles. Angelina Jolie spoke openly about her episode, attributing it to stress – a reminder that even people with extraordinary cheekbones are not immune to neurological mischief. In our part of the world, actors, politicians, news anchors, and at least three uncles at every wedding have experienced it, usually just before an important family photograph. Bell’s palsy, it seems, enjoys timing. It humbles celebrities, startles patients, and reassures everyone else that a crooked smile does not diminish charm; it merely adds character.
Treatment is straightforward. Steroids. Eye care. Reassurance. And patience – the most under-prescribed medication in modern medicine. Recovery usually follows, slowly and unevenly. The smile returns before the blink. The blink before the eyebrow. The face, like a stubborn orchestra, tunes itself instrument by instrument.
The gentleman listened carefully as I explained all this. He nodded, mostly with the functioning side of his face. “So, you’re saying,” he asked, “that this will get better, but not immediately?” Exactly. Weeks later, he returned looking lighter. His eye closed again. His smile was symmetrical enough to fool strangers. His wife leaned over and whispered, “He’s back to annoying me evenly.”
The pons also plays a role in sleep and dreaming, which perhaps explains why patients with Bell’s palsy often report vivid dreams during recovery, the brain rehearsing expression before executing it. Or perhaps the pons simply enjoys drama.
The pons teaches us something essential: that connection matters. That expression is neurological before it is emotional. That even our most personal gestures depend on small bridges deep inside our heads working quietly. And that sometimes, losing your smile temporarily makes you appreciate it more when it returns.
On his final visit, the gentleman grinned fully and said, “Doctor, I can finally take selfies again.” His wife smiled too. The pons had done its job. And, for once, diplomacy had worked well.
28 thoughts on “The brainstem part 2: The pons”
Too good ! Amazing. You r fantastic doc. Kp it up
Fantastic as usual. Dr, your articles are gifts to us every Sunday!
Excellent as usual
Every medical student should learn brain anatomy from you taught with real life drama
Very interesting these pons.who would imagine something inside one’s own brain working tricks and making u look like u never wanted to .Thank u for another eye opener of our own anatomy.
The Seventh Nerve Palsy is taught to us, but never like this. You are wonderful as usual. Some day teach us like this for “it’s cause” also
Dear Maz,
Another masterpiece of communication and connection!
Loved the article!
Eagerly wait for Sunday mornings to read your MOST INFORMATIVE articles!!
Awesome.
Ahhh ok! So Pons orchestrates response and sometimes pawns it too!!
Thank you for another excellent article that reveals the remarkable workings of our brain.
Excellent Dr Turel – you have expressed PONS very well 💐
After reading every article of yours, one gets to add to their knowledge. Today was no exception a truly brilliantly written lucid article dear Mazda.
Sunday Ponanza from the master story teller!
Fascinating…both the facts about this mysterious yet vital part of the brain and your detailed and lucid explanation! Thank you for demystifying these processes for all of us. And thank God for the happy ending if this story!
An eye opener and new learning every time – thank you doctor! Steroids and patience work hand in hand to cure one.
Enjoyed my Sunday morning sermon.
Dhanyavad 🙏
Every Sunday it’s jus a joyful eyeopener series . Thank you Mazda . Loved it 🫰♥️
Thank you for yet another masterpiece,Dr.
You write so beautifully that it feels like a literal tour inside the brain
Very fascinating and something to ‘pon’der about!
Fascinating article. Something i never knew about. Keep it up.
Awesome..who would have thought the Pons makes you handsome when it is in full flow! George Clooney smile is a great example!
Have been reading your article for many years and the most surprising thing- After reading every article the thought comes in mind: Is there anything left to describe about this less than 1.5 kg matter? But the next article reveals it is an ocean where we cannot even imagine what will be next topic…Thank you.
Pontine demyelination and tumors.. these are the words I get to hear and see mostly. But this one gave another dimension . Very nicely written Sir
Talking about brain is confusing, too delicate to fool around and only doctor has its solution so next time don’t fool around.
So beautifully and in simple language about Bell s palsy,
Another superb article , so articulately penned. Thank you Doctor.
Excellent. Thank you Dr.
Brilliant Dr. Turel,
Always informative! Pons and Bell’s Palsey.
Something new.
So well penned.
We always await for your article.
Amazing piece…yet again doctor. You have made my studies of the brainstem so vivid now!
Wonderful, Brilliant 👌👍🤗
Incredible Information Dr.