1E
Unusually, two different versions of the otyugh are described in the original Monster Manual, listed in separate entries rather than as sub-headings as is the case with various types of sphinx and so on. The larger one is said to be 3 feet (1 metre) in height, although the accompanying illustration shows it at nearly twice that and also proportionately taller than the text implies. The general body form is the same in both, although the larger one has what looks like a shaggy pelt rather than hairless skin and has a much smaller mouth (the bite does less damage, so this may be intentional).
The main body of the otyugh is roughly domed in form and is supported by three legs. These lack visible knees and end in toeless circular pads. They don't seem very flexible, which would help to explain why the creature moves so slowly but would probably give it a stable footing. There is no distinct head, with the mouth simply being placed at the front of the body above the two forelegs - it's said to be "sucker-like", but actually seems to have horizontal jaws. Two tentacles arise from the side of the body, ending in leaf-like pads similar to the clubs on the end of squid tentacles. Sharp spines project in an irregular pattern along the lengths of the tentacles, and there are many smaller ones on the underside of the pads. A third tentacle or flexible stalk arises from the creature's hindquarters, above the single rear leg, and this has two vertically placed eyes on it the shape of which implies that they have eyelids. In the larger species, this tentacle ends in a rounded structure that may be intended to be a third, lidless, eye.The creature is surprisingly intelligent, with the larger ones being fully equivalent to the average human. They have their own language, but are also telepathic and able to communicate with humans although why they might want to is unclear. Perhaps the telepathy is more useful for placating other monsters and allowing them to clean up carrion and other detritus unmolested.
The 2E version has stubby limbs that look as if they do possess knees, albeit ones of limited mobility, and end in four sturdy claws of the sort that would be more suited to digging through refuse than attacking prey. The hide is stony with an almost cobbled appearance and sparse hair. The tentacles have spines only on the pads, while the eyestalk has three bulging lidless eyes close to the tip. Apart from these cosmetic changes, however, the creature seems essentially similar.
3E
The body is much flatter in this edition, lacking the large domed part above the mouth. Indeed, the mouth is huge in proportion to the body, surely much larger than the stomach, and leaving relatively little room for all the organs in the creature's hind part. It's also obviously jawed now, and not at all sucker-like. The rocky skin is hairless, which the smaller version may well have been in 1E. The legs have obvious knees, all of which bend to the rear, and end in three toes with heavy, partially hoof-like, claws. The text states that the eyestalk has only two eyes, as in 1E, but the accompanying illustration clearly shows three.
The single version (ignoring the standard "advancement" option) described is somewhere between the larger and smaller ones of earlier editions. It's the same size as the larger one, but the thickness of the hide and the stated hit dice match the smaller version. The intelligence is way down, barely more than bestial, although it is enough to allow it to speak. Rather than have its own language, which was stated to be largely non-verbal in 2E, it speaks the Common Tongue... albeit presumably with some difficulty. This, most likely, compensates for the loss of the telepathy.
We're also told that the otyugh has an especially keen sense of smell, similar to that of, say, a dog. They're more sociable than before, sometimes being found in small groups of up to four individuals. The fact that these are described as "clusters" however, implies a distinct lack of any pack structure and that they're more likely just tolerating the presence of close neighbours in areas with abundant food.
5E
In 5E, the jaws project further forward from the body, to which they are attached by a thick 'neck'. As in earlier editions, the teeth are sharp and isodont, suitable for biting into slippery food. These would normally suggest a fish-based diet, although in fact we know that the animal is a scavenging carrion feeder. It's notable that they wouldn't be of much use in cracking bone to get the marrow out, as hyenas do, although they'd probably be fine for gnawing on the surface. While the mouth is still large, and probably more so than the stomach, the torso proper is more elongated and has more room for internal viscera than it did in 3E.
The limb structure is broadly similar to that in 3E and one illustration shows that the creature has a gait similar to that of many tetrapods, but with the single hindleg taking the place of what would otherwise be a pair. For the first time, however, it is not a lumbering slow-moving creature, being able to keep pace with a typical human although no more than that.
The creature still has three eyes on its sensory tentacle, and this time, this is not contradicted by the text. The close-up shows slit-like pupils, presumably contracted in the light, since the creature is, like many real-world subterranean animals, photophobic. A series of three to five spines lines the back of the sensory tentacle; they might be protective but could also be sensory since we are told that the creature's nostrils are also on the stalk, so other sense organs might be, too.
The otyugh here is stronger and more physically resilient than the one in 3E which could be taken as indicating that it's supposed to be the larger sub-type insofar as any such distinction still exists. The intelligence remains lower than in 1E, but it has regained its limited telepathic powers and its native language (probably still non-verbal, although this isn't stated), losing the ability to speak Common.
It's obvious that the otyugh doesn't resemble any real-world creature even to the extent that, say, a griffon or a dragon does. Its status as an "aberration" cements that; it's intentionally weird. Thus, even compared with the roper, there is a limit to how much we can predict about its internal anatomy and biology. But that isn't to say that we can't say anything or use some reasonable guidelines to speculate.Firstly, from 3E onwards we can clearly see from its limbs that the creature possesses an internal skeleton and, moreover, that the individual limbs have a basically tetrapod layout. Of course, they aren't tetrapod numerically, but the structure of the limb skeleton does seem similar, just with two forelimbs and a single hindlimb.
How the skeleton would work in the rest of the body is much less clear. For reasons of weight-bearing something similar to ribs would seem plausible, and the forelimbs are probably attached by something similar to the pectoral girdle (that is, shoulder blades and collar bones) of vertebrates. Perhaps there's a narrow plate-like bone taking the place of the pelvis at the rear and, if so, this would probably articulate with whatever bone runs the length of the body to attach the ribs. The general shape of the body in 5E suggests that this is similar to the backbone of regular vertebrates, with a sternum on the ventral surface, but this is rather less obvious in the more dome-like bodies of earlier editions.
The jaws attach to the front of this arrangement, perhaps via powerful muscles rather than a bony joint, but there's clearly no skull in the usual sense. The tentacles might also have bones inside, since this would be more useful for support in air than the boneless muscular arrangement of an octopus's limbs but, if so, they'd presumably resemble a flexible spine and would need some kind of joint to be attached to a modified "rib" at the relevant level in the body, or to the central supporting bone in the case of the eyestalk.
In terms of the soft anatomy, the fact that the otyugh is large and air-breathing does at least make it clear what general organ systems it must have in order to function. If it breathes air and is too large for a tracheal system to work, it must necessarily have lungs of some kind, although their structure, layout, and position could be almost anything. There's no evidence of nostrils on any otyugh illustrations. It's possible that this means it breathes through its mouth, which suggests that it's unlikely to want to keep that fully closed for long - although it could, whale-like, stay submerged beneath effluent for long periods to lie in wait for ambulatory prey.
Despite the lack of visible evidence in the picture, however, the 5E text states that the "nose" is on the eyestalk, which it presumably uses like a snorkle. In this case, the lung or lungs would be entirely detached from the digestive system, which at least means the otyugh can't choke, and would likely be located somewhere in the rear part of the dorsum (upper surface). In theory, however, the term "nose" could just refer to the olfactory organs, which don't absolutely need to be attached to the respiratory system.
In order to get that oxygen to the tissues of the body, a large creature also needs a circulatory system, including at least one heart. Putting it near the lungs makes sense, but isn't essential. It also needs a digestive system, although with carrion and offal as the main food source, it needn't be an especially complex one. It may even be that the mouth is large enough to store food, limiting the need for a large, or perhaps any, stomach. The existence of an intestine is, however, unavoidable.
The creature also needs to excrete. The anus is probably just forward of the hind limb, which is of the right shape to bend back out of the way. Kidneys of some kind are essential to remove metabolic byproducts; they might exist through a urethra as in most mammals, a cloaca as in reptiles, birds, and so on, or straight into the intestine as in many invertebrates. There might be one, two, or several; there really is no requirement beyond the fact that they be there.
The position of the brain is an interesting question. In essentially all real-world creatures advanced enough to have one, this is at the front end, probably because that's where all the sense organs are if an animal wants to know where it's going. But the otyugh's eyestalk is at the rear, so the brain may well be, there too, down near the animal's rump at the base of the stalk. Perhaps there's a cranium there, since the brain would need protecting. The main nerve cord probably runs along either the back or the underside, but there's no especial reason why it would have to be either. It's also worth noting that the stalk probably has other sensory organs besides the eyes. For instance, the spines on the rear might be sensitive to aerial vibrations and used as ears, or they could be what it uses to smell.
Rooting around in the abdominal cavity of a dead otyugh would doubtless reveal other organs, the exact function of which might not be obvious to a sage with medieval-level knowledge. There could be a liver, a pancreas, spleen, endocrine organs and so on, but these wouldn't have to parallel those of vertebrates, and might well be quite different in form.
One other organ system the otyugh definitely needs is a reproductive one. 2E states that otyughs have a distinct breeding season, which seems odd for something so subterranean. Animals have breeding seasons so that they can ensure that their young are born at the right time of year, be that spring, the rainy season, when fruit is most plentiful, or whenever. But the underdark must surely lack anything much in the way of seasonality, so one time of year is as good as any other, and without changes in day length or temperature how would you even know what season it was anyway? It's not as if, like bats, they come out of their caves to feed.
At least in later editions, otyughs don't encounter one another all that rarely, and it seems likely that there are distinct male and female sexes, rather than them all being hermaphrodite, although we can't be sure of this. On the balance of probabilities, female otyughs probably also lay eggs, which they could incubate in a dung pile or the like. Young do seem to sometimes be found close to their mother, so there's presumably some degree of parental care before they are old enough to fend for themselves.
Finally, we come to the otyugh's signature power, which is the ability to transmit disease to those it bites. 1E states that the disease in question is typhus, a disease spread by lice or fleas. Which makes absolutely no sense for a disease passed on by a bite, rather than by skin contact. Furthermore, lice tend to specialise on particular hosts. While one could well believe that, say, a dwarf is similar enough to a human to serve that role, an otyugh seems a lot less likely. Fleas might be a different issue, and there is a (rare) form of typhus that can be contracted from mouse fleas, but even then it's a bit of a stretch. But, if the disease somehow is typhus, at least you've got that two-week incubation period in which to get your cure disease spell in.
In any event, the disease clearly isn't typhus in later editions. In 3E, it's named as "filth fever" giving us some idea of the primary symptom. If the disease is transmitted through the otyugh's saliva the best analogy is probably rat-bite fever since the symptoms (to the extent that they're described) don't seem to fit with more obvious candidates such as rabies. One might be tempted, incidentally, to think that the bite of a komodo dragon, said to be full of toxic bacteria, would be another good analogy... but it seems that that's probably a myth.
It's more likely, however, that the disease is intended to be contracted from the rotting material that the otyugh eats. Contact with such material can cause a number of diseases which, as it happens, can include typhoid, a disease with similar symptoms to typhus (hence the name) but that's otherwise entirely different. But it's more likely that we're simply talking some form of bacterial sepsis. This can be caused by a wide range of different pathogens, has fever as its primary symptom, and is often lethal. It's typically not quite as rapid as "filth fever" is said to be, which has a virtually instantaneous onset in 5E but that could be a side-effect of living in a magical world.
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