University of Portsmouth PhD graduate awarded Hunterian Lectureship by the Royal College of Surgeons of England

How did it feel to be awarded the Hunterian Lectureship (2026) by the Royal College of Surgeons of England?

Receiving the Hunterian Lectureship is one of those moments that stops you in your tracks. I have spent thirty years treating some of the most complex facial injuries imaginable — patients arriving after road traffic collisions, industrial accidents, high-energy assaults, or conflict-related trauma — and for much of that time the scientific question driving me has been the same: why do two patients with apparently identical injuries sometimes follow completely different clinical paths? To be recognised by the Royal College of Surgeons for the body of work that has grown from that question is genuinely humbling.

The award has particular personal resonance because the mentor who first encouraged me to pursue academic surgery, Professor David Poswillo, was himself a Hunterian Professor. His belief in the importance of evidence-based surgical science shaped my entire career, and I feel very conscious of carrying something of that tradition forward.

Could you explain what the Hunterian Lectureship is and what it represents?

The Hunterian Lectureship is one of the oldest and most prestigious awards in British surgery, established to honour the legacy of John Hunter — the eighteenth-century anatomist and surgeon whose insistence on observation, experiment, and scientific rigour transformed surgery from a craft into a discipline. Hunter believed that understanding why an operation worked was just as important as performing it skilfully; his notebooks, specimens, and comparative anatomy collections, now housed at the Royal College of Surgeons, remain an extraordinary testament to that philosophy.

What makes the award especially meaningful to me is its institutional geography. The very first Hunterian lectures were delivered in 1805 by William Blizard, a surgeon at the London Hospital in Whitechapel — the same institution that is now the Royal London Hospital, where I have worked as a trainee then Consultant Craniofacial Trauma Surgeon for the past three decades. There is something rather remarkable about that continuity: from Blizard’s first lecture in 1805 to my lecture in 2026, the thread runs through the same building and the same patient population. Later, Frederick Treves — perhaps best known today for his care of Joseph Merrick — delivered his own Hunterian lecture from the London Hospital in the 1880s, adding another chapter to that story.

For surgeons in Oral and Maxillofacial Surgery specifically, the Hunterian Lectureship is exceptionally rare. Only a handful of OMFS surgeons have been selected across the award’s long history — my predecessors in the specialty include Professors Simon Rogers and Peter Brennan. Being admitted to that company is not something I take lightly.

Can you tell us more about the topic of your lecture?

The lecture is titled “Creating Order from Chaos: A Hunterian Journey in Craniofacial Trauma — 30 Years of Service, Science, and Structure.” It tells the story of how I came to believe that the way surgeons classify and communicate facial injury has been fundamentally inadequate, and what I have done about it.

Facial fractures are among the most anatomically complex injuries in trauma surgery. No two are the same — a fracture of the cheekbone in a fit twenty-five-year-old is a completely different clinical problem from the nominally identical fracture in a sixty-year-old with diabetes and periodontal disease, even if both look the same on a CT scan. For decades, surgeons have relied on classification systems — such as the Le Fort levels or the Zingg zygomatic system — that describe fracture anatomy but say almost nothing about a patient’s biology or the burden on the soft tissues that surround the skeleton. The result is what I call an “illusion of agreement”: two patients receive the same classification label, but one sails through surgery and the other develops a serious infection or requires revision surgery.

Over the past 2 decades I have developed, with colleagues at the Royal London Hospital, the ZS Craniofacial Disruption Score — a three-dimensional scoring model in which fracture complexity, biological risk, and soft tissue burden are combined to generate a single volume score that genuinely predicts outcome. The mathematics is deliberately Hunterian: outcome equals technical challenge multiplied by biological environment. The lecture traces how that idea evolved from clinical observation, through data from over hundreds of patients, to a validated international scoring tool now in use in several countries. It is, at heart, the story of what happens when you refuse to accept that the existing categories are good enough.

Could you share an overview of your PhD research, as well as your experience studying at the University of Portsmouth?

My PhD, completed at the University of Portsmouth under the supervision of Professor Graham Mills, was honestly one of the most joyous intellectual experiences of my career — second only, perhaps, to the Hunterian Lectureship itself.

I chose the PhD by publication route, which suited me extraordinarily well as a practising consultant surgeon. Rather than beginning from scratch, this approach allowed me to revisit and synthesise a body of work accumulated over many years — and in doing so, to reconnect with colleagues and friends who had contributed to that work, many of whom had touched my professional life in profound ways. Seeing those collaborations formally structured and interrogated through a doctoral lens was genuinely moving.

The research was broader than a single question. At its heart lay cranio-orbital trauma — the intersection of facial and skull base injury that sits at the most technically demanding end of my clinical practice. The doctoral work encompassed the development and validation of the ZS Scoring System for craniofacial injuries, but it went considerably further than that. I examined outcomes across different patient populations to rigorously test the methodology, and I investigated indicators of anterior skull base injury severity across different mechanisms of trauma — both observationally and mathematically — which deepened my understanding of how the skull base responds to different energy profiles in ways that straightforward classification had never captured.

One of the unexpected pleasures was the historical dimension. The PhD gave me licence — indeed, a scholarly obligation — to delve deep into the history of craniofacial trauma: back to 1907 and 1911, through the First and Second World Wars, into the conflicts in Vietnam and beyond, and eventually into my own thirty-year career on the wards at Whitechapel. That historical arc is not mere background colour; it reveals how slowly the field has moved in developing tools adequate to the complexity of what surgeons actually face. Understanding that history made the case for new methodology far more compelling.

I completed all my post-doctoral objectives and considerably exceeded them, finishing within eighteen months. I would recommend a PhD by publication without hesitation to any senior clinician who believes, as I do, that the questions raised by three decades at the bedside deserve more than a passing answer. Portsmouth gave me the intellectual architecture to do justice to those questions — and I am enormously grateful for it.