In a medium bowl, mix together the white bread, milk, egg and olive oil. Mix together the mixture using your hands and set aside to let the bread absorb the liquid, about 5 minutes.
To the bread mixture, add the oregano, red pepper flakes, lemon zest, garlic, salt, cheese and dry pasta and stir to combine with a rubber spatula. Add the meat to the bowl using your hands, gently mix into the bread mixture until just combined being careful not to over mix. Using a small scoop or a tablespoon, form the mixture into bite sized balls.
In a medium skillet, bring the tomato sauce to a simmer over medium heat. Add the balls to the sauce and cover the pan. Reduce the heat to medium low and simmer for 20 minutes or until the orzo in the meat balls is completely cooked. Serve the balls topped with additional parmesan cheese if desired.