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Conjoined twins are typically classified by the point at which their bodies are joined. The most common types of conjoined twins are:
- Thoraco-omphalopagus (28% of cases): Two bodies fused from the upper chest to the lower chest. These twins usually share a heart, and may also share the liver or part of the digestive system.
- Thoracopagus (18.5%): Two bodies fused from the upper thorax to lower belly. The heart is always involved in these cases. As of 2015, separation of a genuinely shared heart has not offered survival to two twins; a designated twin may survive if allotted the heart, sacrificing the other twin.
- Omphalopagus (10%): Two bodies fused at the lower abdomen. Unlike thoracopagus, the heart is never involved in these cases; however, the twins often share a liver, digestive system, diaphragm and other organs.
- Parasitic twins (10%): Twins that are asymmetrically conjoined, resulting in one twin that is small, less formed, and dependent on the larger twin for survival.
- Craniopagus (6%): Fused skulls, but separate bodies. These twins can be conjoined at the back of the head, the front of the head, or the side of the head, but not on the face or the base of the skull.
Other less-common types of conjoined twins include:
- Syncephalus: One head with a single face but four ears, and two bodies.
- Cephalothoracopagus: Bodies fused in the head and thorax. In this type of twins, there are two faces facing in opposite directions, or sometimes a single face and an enlarged skull.
- Xiphopagus: Two bodies fused in the xiphoid cartilage, which is approximately from the navel to the lower breastbone. These twins almost never share any vital organs, with the exception of the liver. A famous example is Chang and Eng Bunker.
- Ischiopagus: Fused lower half of the two bodies, with spines conjoined end-to-end at a 180° angle. These twins have four arms; one, two, three or four legs; and typically one external set of genitalia and anus.
- Omphalo-Ischiopagus: Fused in a similar fashion as ischiopagus twins, but facing each other with a joined abdomen akin to omphalopagus. These twins have four arms, and two, three, or four legs.
- Parapagus: Fused side-by-side with a shared pelvis. Twins that are dithoracic parapagus are fused at the abdomen and pelvis, but not the thorax. Twins that are diprosopic parapagus have one trunk and two faces. Twins that are dicephalic parapagus have one trunk and two heads, and have two (dibrachius), three (tribrachius), or four (tetrabrachius) arms.
- Craniopagus parasiticus: Like craniopagus, but with a second bodiless head attached to the dominant head.
- Pygopagus (Iliopagus): Two bodies joined at the pelvis.
- Rachipagus: Twins joined along the dorsal aspect (back) of their bodies, with fusion of the vertebral arches and the soft tissue from the head to the buttocks
"'Conjoined twins" are identical twins joined in utero. An extremely rare phenomenon, the occurrence is estimated to range from 1 in 49,000 births to 1 in 189,000 births, with a somewhat higher incidence in Southeast Asia and Africa. Approximately half are stillborn, and an additional one-third die within 24 hours. Most live births are female, with a ratio of 3:1.
Two contradicting theories exist to explain the origins of conjoined twins. The more generally accepted theory is "fission", in which the fertilized egg splits partially. The other theory, no longer believed to be the basis of conjoined twinning, is fusion, in which a fertilized egg completely separates, but stem cells (which search for similar cells) find like-stem cells on the other twin and fuse the twins together. Conjoined twins share a single common chorion, placenta, and amniotic sac, although these characteristics are not exclusive to conjoined twins as there are some monozygotic but non-conjoined twins who also share these structures in utero.
The most famous pair of conjoined twins was Chang and Eng Bunker (Thai: อิน-จัน, In-Chan) (1811–1874), Thai brothers born in Siam, now Thailand. They traveled with P.T. Barnum's circus for many years and were labeled as the Siamese twins. Chang and Eng were joined at the torso by a band of flesh, cartilage, and their fused livers. In modern times, they could have been easily separated. Due to the brothers' fame and the rarity of the condition, the term "Siamese twins" came to be used as a synonym for conjoined twins.
Craniopagus twins are conjoined twins that are fused at the cranium. This condition occurs in about 10–20 babies in every million births in the United States. Among this small group, cephalic conjoining, or craniopagus twinning, represents the rarest of congenital abnormalities, accounting for 2–6% of all conjoined twins. Additionally, conjoined twins are genetically identical and always share the same sex. The union in craniopagus twins may occur on any portion of the Calvary, but does not include either the face or the foramen magnum. The thorax and abdomen are separate and each twin has its own umbilicus and umbilical cord. The union may involve the entire diameter of the head or only a small portion. This suggests that although there are many different kinds of vulnerabilities already known in the scientific community, there are an infinite number of variations that can occur. Most of these variations are based on the rotation of one twin's skull to the other and the different phenotype sub-groups of craniopagus twins are based on all these rotational conformations. Each of these factors (rotation, spot of union) affects the development of the brain, the vascular system within the brain and overall wellness of life both of the twins have outside the womb. Relatively few craniopagus twins survive the perinatal period – approximately 40% of conjoined twins are stillborn and an additional 33% die within the immediate perinatal period, usually from organ abnormalities and failure. However 25% of craniopagus twins survive and can be considered for a surgical separation and several attempts occur yearly worldwide. In the last-half century, many advances in medicine including brain imaging, neuro-anesthesia and neurosurgical techniques have proven that a successful outcome is possible following separation of total craniopagus twins.
Craniopagus parasiticus is an extremely rare type of parasitic twinning occurring in about 4 to 6 of 10,000,000 births. In craniopagus parasiticus, a parasitic twin head with an undeveloped body is attached to the head of a developed twin. Fewer than a dozen cases of this type of conjoined twin have been documented in the literature. Most infants with this condition are stillborn, or die shortly after birth.
In the past, the use of terminology when describing parasitic twins has been somewhat inconsistent. By definition, a parasitic twin is joined to another twin in a certain anatomical location or position on the developed twin's body. The underdeveloped twin is termed the parasite, and the developed twin is termed the autosite. The autosite can have some abnormalities, as well. For the most part, however, it has developed enough that it can live on its own.
Polycephaly is the condition of having more than one head. The term is derived from the Egyptian stems "poly" (Greek: "πολύ") meaning "many" and "kephalē" (Greek: "κεφάλη") meaning "head". A polycephalic organism may be thought of as one being with a supernumerary body part, or as two or more beings with a shared body.
Two-headed animals (called bicephalic or dicephalic) and three-headed (tricephalic) animals are the only type of multi-headed creatures seen in the real world, and form by the same process as conjoined twins from monozygotic twin embryos.
In humans, there are two forms of twinning that can lead to two heads being supported by a single torso. In dicephalus parapagus dipus, the two heads are side by side. In craniopagus parasiticus, the two heads are joined directly to each other, but only one head has a functional torso. Survival to adulthood is rare, but does occur in some forms of dicephalus parapagus dipus.
There are many occurrences of multi-headed animals in mythology. In heraldry and vexillology, the double-headed eagle is a common symbol, though no such animal is known to have ever existed.
Maria and Teresa Tapia (born April 8, 2010) were conjoined twins born in the Dominican Republic. The twins were joined by their lower chest and abdomen and were therefore classified as omphalopagus sharing a liver, pancreas, and a small portion of their small intestine. On November 7, 2011, the twins underwent a successful separation surgery at the Children's Hospital of Richmond in Virginia.
Joseph Banda and Luka Banda (born January 23, 1997, in Lusaka, Zambia) are twin brothers who used to be conjoined. They were born joined at the back of the skull and faced in opposite directions. In 1997, Dr. Ben Carson led a team of 50 Zambian and South African specialists to separate the 11-month-old twins in a 22-hour operation. They did not share any organs, but shared intricate blood vessels that flowed into each other's brains. In 2001, the twins were fitted with artificial skulls to permanently close their heads, and are neurologically normal. In an interview, Dr. Carson stated about the operation:
They are residing in a low-cost/high-density area of Lusaka called Chilenje South.
Two-headed people and animals, though rare, have long been known to exist and documented.
Krista and Tatiana Hogan (born October 25, 2006) are Canadians who are conjoined craniopagus twins. They are joined at the head (the top, back, and sides). They were born in Vancouver, British Columbia and are the only unseparated ones of that type currently alive in Canada. They live with their mother, Felicia Simms, in Vernon, British Columbia and often travel to Vancouver for care at BC Children's Hospital and Sunny Hill Health Centre for Children.
Clarence and Carl Aguirre (born April 21, 2002) are former conjoined twins born in Silay City, Philippines. They were conjoined at the top of the head (vertical craniopagus). In 2003 they were brought to the United States by their mother Arlene in the hope of having them surgically separated. A revolutionary new process was used in separating the twin boys. Because "marathon" surgical operations have historically led to a high rate of mortality and morbidity, Clarence and Carl's doctors chose to separate them in several smaller operations, allowing the twins to recuperate after each surgery.
In October 2003, tissue expanders (pouches filled with saline) were implanted under the boys' scalps. This is common practice in separating conjoined twins, as it creates more skin that can be used to cover the twins' wounds after separation. Over the next ten months, the brothers underwent several more operations to tease apart their joined skulls and brains. On August 4, 2004, the final surgery was completed. All of these operations were performed at Montefiore Medical Center in the Bronx, New York by a team led by Dr. James T. Goodrich, a pediatric neurosurgeon and Dr. David A. Staffenberg, a plastic surgeon. They received most of their post-operative rehabilitation at Blythedale Children's Hospital in Valhalla, New York (Westchester County).
By December 2005, Clarence could walk short distances unassisted, and Carl could walk with a walker. As of August 2014 both boys and their mother live in a donated house in Scarsdale, New York. The twins continue to attend physical therapy at Blythedale. Goodrich says there was some degeneration of Carl’s right parietal lobe: he takes medication to control seizures, can utter just a word or two at a time, and has limited use of his left arm and leg. Both must still wear helmets to protect their brains; when they are fully grown, their skulls will be patched.
Diprosopus (Greek , "two-faced", from , ', "two" and , ' [neuter], "face", "person"; with Latin ending), also known as craniofacial duplication (cranio- from Greek , "skull", the other parts Latin), is an extremely rare congenital disorder whereby parts (accessories) or all of the face are duplicated on the head.
Kendra Deene Herrin and Maliyah Mae Herrin (born February 26, 2002). are former conjoined twins. They were separated in August 2006. They were the first set of conjoined twins to be separated to share a kidney. Kendra retained their shared kidney following the separation surgery, while Maliyah Herrin underwent dialysis until she was transplanted with a kidney donated by her mother in April 2007.
Prior to the separation surgery, medical ethicists in the United States and in Europe discussed whether it was ethical to separate the twins because of the additional risk to Maliyah. Their family and doctors believed separation surgery would give both girls their best chance to live a normal life.
A parasitic twin (also known as an asymmetrical or unequal conjoined twin) is the result of the processes that also produce vanishing twins and conjoined twins, and may represent a continuum between the two. Parasitic twins occur when a twin embryo begins developing in utero, but the pair does not fully separate, and one embryo maintains dominant development at the expense of its twin. Unlike conjoined twins, one ceases development during gestation and is vestigial to a mostly fully formed, otherwise healthy individual twin. The undeveloped twin is defined as parasitic, rather than conjoined, because it is incompletely formed or wholly dependent on the body functions of the complete fetus.
The independent twin is called the autosite.
There are two categories of craniopagus twins:
- Partial Although partial craniopagus is less common than total, it is still a division of craniopagus twins that is worth exploring. This type of twinning is defined as having limited surface area involvement, with either intact crania or cranial defects. In other words, it is a defect of the cranial "coverings." In partial craniopagus twins, the unions are usually frontal and less commonly occipital and vertical. Angular frontal junctions occur when the two twins are joined at any part of the forehead. Occipital twins are joined at the occipital lobe in the back of the head and vertical are joined on the top of the head and usually face opposite directions. The junctional diameter is often smaller in partial forms and occasionally an incomplete layer of bone may be present between the twins. Each child maintains independent calvarial convexities except at the common area of skull junction. The dura of both children may be intact or deficient and cortical gyri may interdigitate. Additionally shared dural venous sinuses is usually absent or if it is present it is negligible. These twins usually undergo successful separation and both twins may live to lead normal lives.
- Total Total craniopagus twins are defined as sharing extensive surface area with widely connected cranial cavities. Among total craniopagus twins, there are four main categories which are then further divided into several subcategories. Frontal, the first category, are when twins are facing each other with the axis of the bodies forming an acute angle. Temporoparietal craniopagi are joined immediately above the external auditory meatus. The third division is the occipital anomaly where the twins are connected in the occipital lobe causing the twins to face away from each other. The final variant is the parietal craniopagus which occurs when twins fuse at the vertex with the axis of the twins forming an obtuse angle. This category is perhaps the most important, or most interesting because the craniums of the two twins share the most veins, lobes and circuitry and is often described as one brain shared by two individuals.
- "Type 1": both children face in the same general directional axis so that the angle between twins is less than 40 degrees. These twins show relatively symmetric superior bi-parietal or vertex compressional flattening.
- "Type 2": both children face opposite directions so that the deformity shows an axial rotation between 140-180 degrees.
- "Type 3": in this variety axial rotation is intermediate between the first two types with a rotation of being between 40 and 140.
Ganga and Jamuna Mondal (born Ayara and Jayara Ratun, 1969 or 1970), known professionally as The Spider Girls and The Spider Sisters, are conjoined twins from a Bengali family in Basirhat, West Bengal, India.
Giacomo and Giovanni Battista Tocci were two-headed conjoined twins born in Locana, Italy between 1875 and 1877 on either July or October 4.
Sirenomelia, alternatively known as Mermaid syndrome, is a rare congenital deformity in which the legs are fused together, giving them the appearance of a mermaid's tail as the nickname suggests.
This condition is found in approximately one out of every 100,000 live births (about as rare as conjoined twins) and is usually fatal within a day or two of birth because of complications associated with abnormal kidney and urinary bladder development and function. More than half the cases of sirenomelia result in stillbirth and this condition is 100 times more likely to occur in identical twins than in single births or fraternal twins. It results from a failure of normal vascular supply from the lower aorta in utero. Maternal diabetes has been associated with caudal regression syndrome and sirenomelia, although a few sources question this association.
VACTERL-H is an expanded form of the VACTERL association that concludes that this diagnosis is a less severe form of sirenomelia. The disorder was formerly thought to be an extreme case of caudal regression syndrome; however, it was reclassified to be considered a separate condition.
Ilona and Judit Gófitz (Hungarian: "Gófitz Ilona" és "Judit"; in contemporary publications: "Helen" and "Judith of Szőny"), also known as the Hungarian Sisters, were conjoined twins from Szőny, Hungary who lived from October 19, 1701 to February 8, 1723. In the image they appear to be pygopagus.
For every 200,000 live births, conjoined twins are born. Conjoined twins are identical and of the same sex one hundred percent of the time and are more common in females than in males. For surgical separations the survival rate of at least one twin surviving is approximately 75%.
Based on statistics, the twins were given a 20% chance of survival at birth . At birth at B.C. Women's Hospital & Health Centre, they were described as "wriggly, vigorous and very vocal." They weighed twelve and a half pounds, not six and a half pounds as reported by some media outlets, when they were born by caesarean section.
The twins have a single body with separate heads and necks, a chest that is wider than normal, two arms, and two legs. At birth, they had a rudimentary arm between the bases of their necks attached to a shoulder blade at the back, being combined parts of Abby's left arm and Brittany's right arm. It was removed, leaving the shoulder blade.
Abby's head tilts laterally outward about 5 degrees to the right, while Brittany's tilts laterally at about 15 degrees to the left, causing her to appear shorter even when seated. Brittany's leg is in fact nearly two inches shorter than Abby's and Brittany tends to stand and walk on tip-toe which has made her calf muscle significantly larger than Abby's. The continued growth of Abby's spine was surgically halted after Brittany prematurely stopped growing. At age 12, they underwent surgery at Gillette Children's Specialty Healthcare to correct scoliosis and to expand their chest cavity to prevent future difficulties with breathing.
Each twin manages one side of their conjoined body. The sense of touch of each is restricted to her body half; this shades off at the midsagittal plane such that there is a small amount of overlap at the midline. Stomach aches, however, are felt only by the twin on the opposite side.
They are effective in cooperatively using their limbs when both hands or both legs are required. By coordinating their efforts, they are able to walk, run, swim, and ride a bicycle normally—all tasks that they learned at a normal speed. Together, they can type on a computer keyboard at a normal speed and drive a car. However, their disparate heights (Abby, , is taller and longer of leg than Brittany, ) led to difficulty in balancing a Segway, as shown in their 2012 reality series.
Polymelia (from Greek πολυ- = "many" plus μέλος (plural μέλεα) = "limb") also known as "hydra syndrome" is a birth defect involving limbs (a type of dysmelia), in which the affected individual has more than the usual number of limbs. In humans and most land-dwelling animals, this means having five or more limbs. The extra limb is most commonly shrunken and/or deformed.
Sometimes an embryo started as conjoined twins, but one twin degenerated completely except for one or more limbs, which end up attached to the other twin.
Sometimes small extra legs between the normal legs are caused by the body axis forking in the dipygus condition.
The twins have individual organs in the upper part of their body, while most located at or below the level of the navel are shared, the exception being the spinal cord.
- 2 heads
- 2 spines merging at the coccyx and joined at the thorax by sections of ribs. Surgery was employed to correct scoliosis.
- 2 completely separate spinal cords
- 2 arms (originally 3, but rudimentary central arm was surgically removed, leaving central shoulder blade in place)
- 1 broad ribcage with 2 highly fused sternums and traces of bridging ribs. Surgery was employed to expand the pleural cavities.
- 2 breasts
- 2 hearts in a shared circulatory system (nutrition, respiration, medicine taken by either affects both)
- 4 lungs with the medial lungs moderately fused, not involving Brittany's upper right lobe; three pleural cavities
- 1 diaphragm with well-coordinated involuntary breathing, slight central defect
- 2 stomachs
- 2 gallbladders
- 1 liver, enlarged and elongated right lobe
- Y-shaped small intestine, which experiences a slightly spastic double peristalsis at the juncture
- 1 large intestine (one colon)
- 3 kidneys: 2 left, 1 right
- 1 bladder
- 1 set of reproductive organs
- 2 separate half-sacrums, which converge distally
- 1 slightly broad pelvis
- 2 legs
Millie McCoy and Christine McCoy (July 11, 1851 – October 8, 1912) were American conjoined twins who went by the stage names "The Carolina Twins", "The Two-Headed Nightingale" and "The Eighth Wonder of the World". The Twins traveled throughout the world performing song and dance for entertainment.