Presurgical Orthopaedics is any treatment that alters the position of the segments of cleft maxilla in infancy prior to lip and palate reconstruction. There are different approaches, with different mechanics, seeking and achieving different end results. This article describes PNAM, a current approach to the traditional method of presurgical infant orthopaedics for patients with unilateral and bilateral clefts of lip and palate. The goal of PNAM is to align and approximate the alveolar cleft segments while at the same time achieving correction of nasal cartilage and soft tissue deformity.