The only ways into these machines would be if the NAT/PAT device were misconfigured, another machine on the secure network were compromised, or another gateway into the secure network was set up. Guess what? All of these things would defeat a stateful inspection firewall as well.
I disagree. (All of the below is hypothetical, I haven't tested it, but I believe it to be true.) Premise 1: The machines behind the firewall are actually on and functioning, and presumably may be even being used. Premise 2: The OS's on the machines will periodically do *some* kind of traffic. Some common examples might be ntp syncronisation, or DNS resolving of an update service for antivirus, OS patches, whatever. The traffic may be provided by the user actually using the machine for whatever real users actually do. Premise 3: Many NAPT's are of the "Cone" type. This is desirable for end users as it allows their applications/devices to use their NAPT busting technologys (STUN, Teredo etc) without having to configure static port forwards. Premise 4: The external port chosen for an outgoing protocol is easily guessed. Many NAPT boxes will prefer to use the same port as the original host, or will assign port mappings sequentially a bit of research here would go a long way, presumably entire networks are likely to be using the same NAPT's in an ISP's provided CPE. Thus, for example if you are running a single host behind a NAPT box that is doing regular NTP queries and I can guess the external port on the NAPT box which with a bit of research I suspect is trivial, I can send that port on your external IP a packet and it will be forwarded back to your machine. This could easily lead to a compromise via a buffer overflow or other exploit. This would primarily work for UDP based services that by design tend to be used over the Internet itself such as DNS, NTP, SIP etc. It seems unlikely that this would work against TCP based services. Exploits in ICMP could also be "tunneled" back through a NAPT box in a similar manner. GRE/IPIP/IPv6/ESP/AH can probably use similar techniques to infect machines behind a NAPT box (Disclaimer I don't know those protocols very well, but on the flipside, I suspect that NAPT boxes don't know them very well either and do dumb things with them like forward all GRE packets to the one host inside your network that has ever spoken GRE). Just because you've never seen someone exploit through a NAPT box doesn't mean it won't happen.