In any event, "ettin" is simply another, and older, word for "giant". In D&D, however, it specifically refers to a kind of two-headed giant; this is original to the game, but has been adopted by some other writers and computer game designers since.
1E
The ettin first appears as a giant two-headed humanoid, standing 13 feet (4 metres) tall. This is about mid-sized for giants, being slightly taller than a 1E stone or fire giant. As with many such creatures, their skin is remarkably tough, being as difficult to penetrate as plate metal, and marginally more so than the skin of a hill giant. We don't know their exact strength in this edition, but judging from the weapons they use, it's likely equivalent to a stone giant, which makes sense given their height and build. Their physical toughness is, however, closer to frost giants, perhaps reflecting their heavy bulk and wider torso.
It's said to be obvious from their appearance that ettins are "closely related" to orcs, but this is a stretch judging from the picture. Apart from the second head, the only non-human feature they possess is an upturned, somewhat pig-like nose, whereas orcs have an entirely pig-like head with a heavy snout and nose-disk. Ettins are, like hill giants, unintelligent brutes, seemingly lacking any meaningful culture, and they live in extremely small groups, much smaller than those of giants. For once, there is no indication that the females are any weaker or less common than the males, and they also lack regular giants' knack for throwing large rocks.
The 2E version are said to be similarly orc-like, but if anything, look even less so, with wide mouths and snub noses rather than the protruding tusked jaws of 2E orcs. They also have human-coloured skin, and arguably resemble hill giants more than anything else. Their language is nonetheless, a close variant of orcish, although their habits and society are even more simple and brutish than those of either orcs or hill giants. Whereas regular giants have increased in size in this edition, ettins have not.
3E
The orcish resemblance is rather stronger this time round, with a similar skin colour and enlarged tusk-like canine teeth in the lower jaw. Even so, they are more like a gorilla than an orc, with heavy brow-ridges, a prognathous jaw and short hair that's more like fur than the long locks of the orc. The arms are similarly long and ape-like, and the legs heavy and graviportal - as suits something of their size.
The description of ettin society and language is essentially unchanged from 2E. They still live in very small groups, occasionally accompanied by bands of orcs or goblins, but clearly having no meaningful culture of their own. They retain the same low intelligence as hill giants, so that both orcs and goblins should be able to outsmart them and are likely dominant in their groups (or they'd run away, since the ettins don't build anything that could imprison them). On the other hand, they have acute senses, something also implied in earlier editions.
The hide of ettins is confirmed to be remarkably resilient. However, it is slightly less so than before, and we're told that they often wear thick leather armour for added protection - although the illustration doesn't show this, and one wonders who would make it. Perhaps the most surprising revelation is that, despite their larger size and seemingly powerful build, they are actually less strong than hill giants, albeit more so than an ogre. Gone are the days when their blows were as powerful as those of stone giants...
5E
Ettins are at their most orcish in this edition, having very similar facial features to the 5E version and greatly enlarged tusks. (It's hard to see how these would be much use, given that their flat faces mean they can't slash with them as animals such as warthogs do, and, if anything, they'd make it awkward to eat). They seem to have comparatively short legs, but their thighs are narrower than one might expect, leaving a wide gap between them that suggests an odd anatomy. Although the text implies otherwise, the picture shows some degree of pride in their looks - it must take some effort to braid all that hair, and even face-paint seems more trouble than they would have gone to in previous editions.
While we are given slightly more information about how having two heads affects their personalities and disposition, most of the statistics are similar to those in 3E. How tall they are isn't stated, but their strength is now equivalent to that of a hill giant, if not quite as high as it apparently was originally. Their skin, however, is now simply leathery, and no longer especially impervious to blows. Their intelligence remains unchanged, but, since that of ogres and hill giants has dropped, they're the smarter of the three now... if not by very much. They no longer have their own pidgin language, instead speaking the languages of both giants and orcs - although possibly not very well.
There are, of course, no real-world creatures that naturally have two heads. It does, however, occur from time to time as a physical anomaly, an extreme form of conjoined twinning. The unfortunate individuals typically die either before or shortly after birth/hatching, but there are rare instances of survival into adulthood - snakes seem particularly able to manage this, but it has even been recorded among humans.
Even so, it's exceedingly rare, typically requires some duplication in the other organs, and is inevitably going to be associated with other forms of disability. Ettins, however, while they may be originally the result of a curse, are a "naturally" two-headed race, one that's biologically adapted to working this way. While this makes no sense in evolutionary terms, once that curse (or divine creation) has occurred, there's no inherent reason why such an animal couldn't function well enough to survive and perhaps even prosper.
When we consider the ettin's anatomy, the first point to bear in mind is that the body below the neck appears entirely normal for a humanoid, apart from having unusually broad shoulders. Nothing below that, it appears, is duplicated. We can assume that the relevant blood vessels and so on are doubled, to ensure a proper blood supply from a single heart. So, for example, there are four carotid arteries, two branching off from the aorta, and two from the brachocephalic trunk, rather than one from each. That's not likely to be an issue, but other problems do arise.
The skeleton itself is simple enough to envisage; it's presumably that of a normal humanoid except that the vertebral column divides in two, likely somewhere between the shoulder blades. But we do have an issue with some of the neck muscles. Many are entirely inside the neck, and so entirely normal, but some of the more important ones are supposed to attach to bones in the chest at the lower end.
The most obvious here is the sternocleidomastoid muscle, a very visible muscle that runs from the rear side of the skull down to where the clavicle (collar bone) meets the top of the sternum (breast bone). We can, in fact, see this muscle in the 3E illustration of the ettin, on the right side of the left neck (the medial surface, anatomically speaking). But this is where the problem lies. The muscles on the right side of the right neck and the left side of the left neck (anatomically, the lateral sides) will work as normal... but where do their medial counterparts attach at the lower end?
There isn't enough space for them to do so, and they aren't the only muscle on the medial side of the neck that lacks anything to attach to. Conceivably, one could have some extra bones around here that might help, at least a little, although the 3E illustration shows that the clavicles and the top of the sternum have an entirely normal form, so far as we can see externally, which is difficult to imagine if there's an extra bone there.
The end result of this is that ettins would have some difficulty rotating and nodding their heads. Not that they couldn't at all, since half the muscles work normally and the others just aren't as firmly attached as they should be (they might be tied together at their base by a ligament, for instance) but their motion would be limited and there would likely be issues in moving the two heads entirely independently.
Which might at least mean they don't accidentally bang their heads together if they try to look in opposite directions at once...
Further down into the chest, we find that ettins have two oesophagi, and these must join up before entering the single stomach. Which does mean that, if one vomits, they both do, but otherwise isn't too significant. The same logic would imply that the two tracheae join up before splitting again, forming an X-shape. But it's at least as likely that they remain separate and parallel, each head being connected to a single lung. Either way, you'd have to restrict both air passages to suffocate them.
Having two necks, they also have two thyroids, but that's not the sort of organ where duplication would be a problem.
The other system where issues do arise, though, is the nervous system. It's clear from right back in 1E that each head controls the arm on that side, and it's later clarified that this applies to that entire side of the body. That is, while there's only one backbone, the spinal cord is at least functionally, and perhaps anatomically, split into two parallel structures, each with nerves branching off to only one side of the body.
Which must make it difficult for them to learn to walk as infants, especially given their generally uncooperative attitude. Still, once they've got the hang of it, it should become instinctive and no harder than, say, being part of a rowing team or riding a tandem bicycle.
Arguably a more significant consequence of having two heads concerns sleep. This is because we know that the two heads of an ettin don't sleep at the same time. On the plus side, this means that they're always at least somewhat alert to their surroundings. On the negative... well, if they need as much sleep as humans (and there's no reason why they wouldn't), then they spend a third of their time with the right head asleep, one third with the left head sleeping, and only one third fully awake.
Which, if one head controls half the body, makes them essentially incapacitated for two-thirds of their lives, able to do little more than scratch themselves while the other side snoozes, leaving that arm and leg non-functional. Sure, they can wake up the other head quickly enough if they are attacked by pesky adventurers, but that's got to be an inconvenience.
There's also the issue of how the nerves interact with the bodily organs that aren't paired, such as the heart, bowels, and bladder. While the relevant nerves do originate in pairs from either side of the spinal cord or brainstem, they often connect up again in complex plexuses and, at the end of the day, there's still only one organ to control.
In some cases, it's possible that an "averaging out" of the signals from the two brains might not create too many problems. And the two brainstems, experiencing feedback from the same organs and being in the same hormonal environment, might be more in tune with one another than the higher centres of the brains appear to be. But there's still the question of, for instance, who decides when to pee.
Do they have to agree? And what happens when they don't? 2E provides one possible answer in that it describes the right head as "dominant", so it could be that this has a sort of veto over such unitary functions, at least when it's awake. But, even if this is so, the fact that the relevant nerves are paired probably means that both heads can feel sensation from singular organs.
Which may have relevance for reproduction.
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